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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by jerseygal1 on October 28, 2011, at 16:30:26
My pdoc discussed the possibility of trying a new med with me and he's basically going to leave the choice up to me. I was on prozac long term before it pooped out, then we tried lexapro which didn't work, and then pristiq which also didn't work. We also tried adding zyprexa and lithium to the pristiq (at different times of course) and that didn't work. So without moving into the tricyclics or MAOI's, I can try zoloft, viibryd or paxil. I've been reading some of the boards and it doesn't seem like viibryd had been a big hit. Of the three, what has been the best SSRI for people and one that doesn't cause anxiety since I'm anxiety prone.
Posted by creepy on October 28, 2011, at 17:23:00
In reply to Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by jerseygal1 on October 28, 2011, at 16:30:26
If anxiety is a larger issue than depression Id look at paxil.
TCAs can be good on anxiety but they come with some side effects.
Posted by bleauberry on October 28, 2011, at 18:06:25
In reply to Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by jerseygal1 on October 28, 2011, at 16:30:26
My two cents, zoloft with nortriptyline.
Posted by Phillipa on October 28, 2011, at 18:10:30
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by bleauberry on October 28, 2011, at 18:06:25
Not mentioned but luvox. Also Jerseygirl what sites did you read the reviews on viibrd on? Phillipa
Posted by Brainbeard on October 28, 2011, at 18:40:02
In reply to Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by jerseygal1 on October 28, 2011, at 16:30:26
Zoloft can be one of the worst SSRI's with regard to initially worsening anxiety, although this is bound to happen with any SSRI. Zoloft (sertraline) tends to be more activating though, which is more likely to worsen anxiety in the beginning of treatment (first two to four weeks, usually).
Paxil mostly zonked me out when I started using it, although it too gave me extra anxiety for the first four weeks. It was a fine antidepressant, eventually, but did not do all that much for my OCD anxiety. It was, however, a very pro-social drug for me and I think that for social anxiety it can work very well.
When my family doc suggested I'd start using meds for my OCD about a decade ago, he let me choose between the 'golden oldie' Anafranil (clomipramine) and applauded newcomer Paxil (paroxetine, actually called 'Seroxat' here in Holland). I chose Paxil. If I had known then what I know now - that Paxil's withdrawal syndrome is hellish and long-lasting, that Paxil made me not care a damn about my girlfriend, that Paxil made me gain weight like mad - (but especially the withdrawal syndrome, which pushed me into a destructive type of depression) - I would have chosen clomipramine.
Posted by jerseygal1 on October 28, 2011, at 19:47:44
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by Phillipa on October 28, 2011, at 18:10:30
Thanks for the feedback. I guess every med has its positives and negatives. Philippa, I was reading through these boards to get information about Viibryd.
Posted by Phillipa on October 28, 2011, at 21:03:47
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by jerseygal1 on October 28, 2011, at 19:47:44
Oh I wonder what google also has? Also first ad ever was paxil l0mg with low dose benzos no weight gain and the withdrawal was done in two weeks smaller dose each day and easy. Phillipa
Posted by jono_in_adelaide on October 29, 2011, at 3:45:39
In reply to Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by jerseygal1 on October 28, 2011, at 16:30:26
Given the different things you have tried, could I suggest you use a combination approach - 50mg of Zoloft in the morning, and either 75mg of nortriptyline at bedtime, or 300mg of bupropion in the morning
Posted by SLS on October 29, 2011, at 4:47:49
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by jono_in_adelaide on October 29, 2011, at 3:45:39
> 50mg of Zoloft in the morning
Do you think higher dosages of Zoloft are ever warranted?
I find that, if a combination of antidepressants is going to provide me with any relief, I need to take full therapeutic dosages of each of them. These are usually at or close to the maximum accepted dosages recommended. In other words, I can't reduce the dosages of antidepressants just because I am combining them. This applies to drugs that have different mechanisms of action. I don't know if this applies to taking multiple SRI drugs.
- Scott
Posted by jono_in_adelaide on October 29, 2011, at 7:30:11
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil? » jono_in_adelaide, posted by SLS on October 29, 2011, at 4:47:49
well, the dose/response curve for SSRI's is quite flat in simple depression, somewhat steeper in panic disorder, agraphobia and OCD...... so for most people with depression, 50mg per day will it, but most isnt everyone, you're obviously one of those who benifits from a higher dose.
Posted by jerseygal1 on October 29, 2011, at 10:34:50
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by jono_in_adelaide on October 29, 2011, at 7:30:11
Thanks jono_in_adelaide. Someone has once suggested zoloft together with nortriptyline to me. Sounds like somethings to discuss with my pdoc. Does anyone know if zoloft causes alot of start-up anxiety?
Posted by Brainbeard on October 29, 2011, at 16:12:00
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by jerseygal1 on October 29, 2011, at 10:34:50
> Does anyone know if zoloft causes alot of start-up anxiety?
You mean, anyone other than me? Cause I already told you that Zoloft is the worst for start-up anxiety.
Actually, taking nortriptyline alongside it may well lessen start-up anxiety (by virtue of 5HT2A-antagonism).
Posted by gadchik on October 29, 2011, at 16:18:31
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by Brainbeard on October 29, 2011, at 16:12:00
When I started zoloft 2 yrs ago, tapered off in april,I was on remeron 7.5mg,along w/klonopin.5mg.I had no anxiety,did the remeron have some action that caused that?
Posted by Brainbeard on October 29, 2011, at 16:24:13
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil? » Brainbeard, posted by gadchik on October 29, 2011, at 16:18:31
> When I started zoloft 2 yrs ago, tapered off in april,I was on remeron 7.5mg,along w/klonopin.5mg.I had no anxiety,did the remeron have some action that caused that?
Yeah, Remeron (mirtazapine) is a 5HT2A-antagonist too, and of course Klonopin (clonazepam) is an anxiety-buster deluxe.
Posted by jono_in_adelaide on October 29, 2011, at 16:59:50
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by jerseygal1 on October 29, 2011, at 10:34:50
Zoloft can cause start up anxiety, but nortriptyline helps block this effect (5HT2 antagonist)
You can also reduce it by taking half a zoloft tablet per day for the first week, then going up to a full tablet.
Nortriptyline can cause some drwsiness in the forst few days, it can be good to start on a friday night, so you have a couple of days to get used to the drowsiness before having to work on minday
Posted by gadchik on October 29, 2011, at 17:11:10
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by jono_in_adelaide on October 29, 2011, at 16:59:50
why cant they make a zoloft pill w/5HT2 antagonism and throw in some gaba magic?
Posted by Phillipa on October 29, 2011, at 18:59:52
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil? » jono_in_adelaide, posted by SLS on October 29, 2011, at 4:47:49
Scott you once posted oh a year or so ago that to take 50mg of luvox an SSRI with 2.5mg of lexapro could cause serotonin syndrome as two SSRI's? Have you taken high doses of SSRI's yourself? Phillipa
Posted by Phillipa on October 29, 2011, at 19:00:46
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by gadchik on October 29, 2011, at 17:11:10
Sounds ideal!!!! Phillipa
Posted by SLS on October 29, 2011, at 19:49:04
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil? » SLS, posted by Phillipa on October 29, 2011, at 18:59:52
> Scott you once posted oh a year or so ago that to take 50mg of luvox an SSRI with 2.5mg of lexapro could cause serotonin syndrome as two SSRI's? Have you taken high doses of SSRI's yourself? Phillipa
I don't remember saying that. If I did say that, I don't remember why. I have not taken two SSRIs together. Serotonin syndrome is usually of some concern in such cases, but I would not insist that it always be a problem. The most dangerous of combinations with regard to the precipitation of serotonin syndrome is that of a SRI with a MAOI.I have taken Zoloft at a dosage of 200mg.
I have not tried Luvox or Celexa.
- Scott
Posted by Phillipa on October 29, 2011, at 20:17:39
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil? » Phillipa, posted by SLS on October 29, 2011, at 19:49:04
I remember as it scared me so never upped the dose. Oh well as my doc at the time said call me if it happens. Phillipa
Posted by Phillipa on October 29, 2011, at 23:40:22
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil? » Phillipa, posted by SLS on October 29, 2011, at 19:49:04
Scott Archieves. Hope the link works if not luvox and lexapro Phillipa
Posted by Phillipa on October 29, 2011, at 23:43:39
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil? » SLS, posted by Phillipa on October 29, 2011, at 23:40:22
Seems you just said be familiar with it. Sorry. Phillipa
Posted by jono_in_adelaide on October 30, 2011, at 7:02:09
In reply to Re: Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by gadchik on October 29, 2011, at 17:11:10
> why cant they make a zoloft pill w/5HT2 antagonism and throw in some gaba magic?
They used to, it was called Limbitrol (atleast here in Australia), a cocktail of amitriptyline and Librium.Given the sedative effects of both, I think people taking it would have been pretty mellow
Posted by Chairman_MAO on October 31, 2011, at 21:06:28
In reply to Med Merry Go Round, Zoloft, Viibryd, or Paxil?, posted by jerseygal1 on October 28, 2011, at 16:30:26
> So without moving into the tricyclics or MAOI's
If you have failed as many drug combinations as you have, you might as well cut to the chase and try an MAOI--or you can try the polypharmacy med-go-round for years with drugs with similar mechanisms of action.
If the MAOI doesn't work, then you can always resume trying 37 other different drug combinations.
There is no "magic bullet", but if you're anxiety-prone, all SSRIs are pretty much the same in that regard and you should try Nardil or Marplan (the former could be more effective than the latter, but the latter is much better with regard to weight gain).
Best of luck.
This is the end of the thread.
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