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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by scleme1 on July 16, 2012, at 12:19:57
I've been a "lurker" here on the boards for a while now. I have OCD (mostly "O"), and I do a lot of reassurance seeking, so I try not to come on med forums too often. Doctor's orders...
However, I am currently in a bit of a mess, and I need to hear from someone with experience. I'm a 38 year old male. I took Paxil 40mg for over 10 years with pretty good results. I'd say that I was symptom free 75% of the time, and managed pretty well the other 25%. I worried a lot about being on it long term, and what withdrawal would be like. That worry would come and go, but was always in the back of my mind. I started CBT and ERP therapy, and my doc wanted me to switch SSRI's to prove that I would be OK.
We cross tapered to 150mg of Zoloft over the course of several weeks. I had no withdrawal or side effects when making the switch. It was very easy. That was November of 2011. I wasn't feeling great at 150 mg after a few weeks, so we went up to 200 mg, and everything was better for a while. I've been on 200 mg for several months now, and I feel horrible.
My anxiety and obsessive thinking are back with a vengeance. The anxiety feels like it did before I started taking anything. My doctor tried augmenting with Deplin, but that had no effect. She then tried augmenting with Buspar, but so far that's not helping either. I've been on 30mg Buspar + the Zoloft a little over a week now. If the Buspar doesn't work, she wants to try augmenting with 2.5mg Abilify.
I'm very worried that I'm not going to find a med that works. My psychiatrist believes that once an SSRI stops working, that the others probably won't work either. I miss Paxil!
I am at the max dose of Zoloft. It should be helping. Am I so jacked up that 200 mg's of Zoloft doesn't help?
My doctor wants to try Luvox CR next, and if that doesn't work...Anafranil.
I guess my main concern is that the Zoloft isn't working, even at 200 mg's. Will I ever find my way back to being symptom free???
Any experience or input would be much appreciated!
Posted by Phillipa on July 16, 2012, at 17:16:23
In reply to Zoloft 200mg not working. Scared + need advice!, posted by scleme1 on July 16, 2012, at 12:19:57
Personally my first ad was l0mg of paxil worked fine after about three months. This was in combination with .5mg of xanax probable three times a day. Long story short stopped the paxil on own as had taken it for two years. I no longer needed it til thyroid went. Then ended up on the generic luvox. I got up to 250mg. Never ever a side effect. I did also take ativan probaly 4-5mg. When on the 250mg of luvox I was relaxed and felt good. So I'd say this could be a good choice for you. I haven't taken the luvox cr. Good luck and welcome to babble. Phillipa
Posted by bleauberry on July 17, 2012, at 5:27:52
In reply to Zoloft 200mg not working. Scared + need advice!, posted by scleme1 on July 16, 2012, at 12:19:57
At this stage of the game.....10 years into ssri's...I seriously doubt any single ssri by itself is going to be of any use to you. However, partner it with a TCA such as Nortriptyline, and it's a whole new world of opportunity. With that in mind, I do not like the abilify idea or the luvox idea, waste of time, but I do like the anafranil idea. It's just easier and cleaner to get a similar effect by combiining zoloft with nortriptyline.
Posted by SLS on July 17, 2012, at 6:04:08
In reply to Re: Zoloft 200mg not working. Scared + need advice!, posted by bleauberry on July 17, 2012, at 5:27:52
> At this stage of the game.....10 years into ssri's...I seriously doubt any single ssri by itself is going to be of any use to you. However, partner it with a TCA such as Nortriptyline, and it's a whole new world of opportunity. With that in mind, I do not like the abilify idea or the luvox idea, waste of time, but I do like the anafranil idea. It's just easier and cleaner to get a similar effect by combiining zoloft with nortriptyline.
Do you dislike the Abilify idea for this case only, or as a general rule? There are scores of people out there with depression who find Abilify to represent the difference between drug failure and complete remission. Abilify helps me more than Anafranil did. I don't think Abilify is a waste of time. Then again, any drug is a waste of time if it doesn't work for the specified individual right?
If you see Abilify as being a waste of time in this particular case, I would greatly appreciate it if you would list your reasons for believing such. Do you feel that there is a certain set of symptom clusters that indicates a failure to respond to Abilify as an augmenting agent? I imagine there are, but I have never thought about it.
Perhaps: non-melancholic, anhedonia, anergia, hypersomnia, loss of interest and motivation, loss of libido, and cognitive slowing among others? Even if one identifies such a relationship, there are bound to be cases that fall outside these parameters who will also benefit from Abilify just as there will be some falling within the parameters who are unresponsive to it.
At this point, I still like Stephen Stahl's characterization of Abilify as being a dopamine system stabilizer (DSS).
Personally, I never excluded a drug from consideration when seaching for something that works for me. I will, however, list potential treatments in an order of priority base upon clinical observations and hypotheses both. However, I think clinical observation trumps theory. Clinical observation indicates that Abilify is effective as an adjunctive medication for treating MDD and BD depression.
- Scott
Posted by herpills on July 17, 2012, at 10:25:58
In reply to Re: Zoloft 200mg not working. Scared + need advice! » bleauberry, posted by SLS on July 17, 2012, at 6:04:08
Hi Scott- My understanding is that the original poster was looking for something to help anxiety. While you are correct that Abilify can help depression, I would have to agree with BB that it is a lot less likely to help with anxiety. In fact, Abilify causes anxiety in some people.
Posted by SLS on July 17, 2012, at 12:07:44
In reply to Re: Zoloft 200mg not working. Scared + need advice! » SLS, posted by herpills on July 17, 2012, at 10:25:58
> Hi Scott- My understanding is that the original poster was looking for something to help anxiety. While you are correct that Abilify can help depression, I would have to agree with BB that it is a lot less likely to help with anxiety. In fact, Abilify causes anxiety in some people.
You are right. It certainly can.
Restlessness, insomnia, and anxiety often occur at the beginning of Abilify treatment and disappear by the end of week 2, if not sooner. These are startup effects only, and are sometimes called "pseudoakathisia". I don't know how common anxiety is as a long-term side effect. As a startup effect, it is very common.
I know a few people who tried Abilify for depression and anxiety for whom it was the anxiety that the drug was most effective for as a treatment.
If it were me, and I were to develop true acute akathisia as a reaction to Abilify, I would contact a doctor right away or discontinue it immediately. People sometimes get suicidal with akathisia.
This is a good summary of the features of akathisia:
"Akathisia: A movement disorder characterized by a feeling of inner restlessness and a compelling need to be in constant motion, as well as by actions such as rocking while standing or sitting, lifting the feet as if marching on the spot, and crossing and uncrossing the legs while sitting. People with akathisia are unable to sit or keep still, complain of restlessness, fidget, rock from foot to foot, and pace."
http://www.medterms.com/script/main/art.asp?articlekey=33264
- Scott
Posted by SLS on July 17, 2012, at 12:11:59
In reply to Re: Zoloft 200mg not working. Scared + need advice! » SLS, posted by herpills on July 17, 2012, at 10:25:58
> Hi Scott- My understanding is that the original poster was looking for something to help anxiety.
Thanks for correcting me. I reread the post and saw that it was OCD and anxiety that were the problematic areas. I didn't it read slowly enough, I think.
- Scott
Posted by jane d on July 17, 2012, at 13:39:46
In reply to Zoloft 200mg not working. Scared + need advice!, posted by scleme1 on July 16, 2012, at 12:19:57
Is there a reason you don't want to go back on Paxil? You say you stopped taking it because you were anxious about it. Had it also stopped working? If not, I'd think trying it again would be your best bet.
Posted by Phillipa on July 17, 2012, at 20:16:00
In reply to Re: Zoloft 200mg not working. Scared + need advice! » scleme1, posted by jane d on July 17, 2012, at 13:39:46
I'd try the paxil and if it doesn't work the luvox cr or better yet the generic as take it twice a day. Seriously even today ocd is so much better even though I only take 50mg the starting dose. My pdoc said I have ocd. And continue on the luvox and low dose of benzo. So I am. I'm one of the few posters that had no side effects on luvox. Probably one of the few who took it. It was initially approved by Servier in the US for OCD and not depression hence never got popular with docs here. But I feel it's a great med. If I was younger I'd most like raise the dose but older folks dont's require as much. Good luck with your decision. Phillipa
Posted by scleme1 on July 18, 2012, at 15:32:05
In reply to Zoloft 200mg not working. Scared + need advice!, posted by scleme1 on July 16, 2012, at 12:19:57
I think the doctor doesn't want to go back to Paxil just yet due to my history with obsessing over withdrawals and effectiveness. I've also seen a lot of reports stating that Paxil doesn't work nearly as well the second time around. I'm waiting to hear back from my MD and psychologist on what they want me to do next. They are working together on this, which is pretty cool, really. If I had to guess, I would say that they are going to want me to try the 2.5 mg Abilify. I guess that's OK, but I'd rather switch over to something in a different class. What I'd REALLY like to do is go back to Paxil 40mg and take my Ativan as needed. The Zoloft alone is definitely not doing its job, though. Tired of feeling this way...
Posted by Phillipa on July 18, 2012, at 21:17:15
In reply to Re: Zoloft 200mg not working. Scared + need advice!, posted by scleme1 on July 18, 2012, at 15:32:05
I say then repeat the paxil as you believe in it and that may well be the key to a med working for you. Personally I have found that if I didn't believe a med wouldn't work the fear kept it from working. Phillipa
Posted by Brainbeard on July 29, 2012, at 16:11:40
In reply to Re: Zoloft 200mg not working. Scared + need advice!, posted by scleme1 on July 18, 2012, at 15:32:05
I had a similar situation where I switched from high dose clomipramine (augmented with fluvoxamine to boost it*), which was effective for depression and OCD, to 200mg Zoloft (sertraline). At first it seemed to be a painless switch, but then anxiety and depression kicked in again big time. :[
Trying all kind of things, one bright morning I popped 1800mg of gabapentin (aka Neurontin) and within a few hours felt great. Relieved from anxiety and in a mood better than well. :D
I still take the gabapentin alongside my 250mg of Zoloft, and it somehow boosts the Zoloft into being truly effective. Gabapentin has serotonergic effects - it makes serotonin more readily available in the body, which is probably the reason why it can boost an SSRI.
I'm experimenting with the dosing of my gabapentin, but usually, it should be taken three times daily.
So adding gabapentin might be an option.
Clomipramine would also be an excellent option, since decades of research show it to be slightly superior to SSRI's for treating OCD.
* Fluvoxamine (better known as Luvox) inhibits the breakdown of clomipramine into its noradrenergic metabolite, desmethylclomipramine. The noradrenergic metabolite works well for depression but probably doesn't help much with OCD.
Posted by brynb on July 31, 2012, at 9:53:10
In reply to Gabapentin (Neurontin), posted by Brainbeard on July 29, 2012, at 16:11:40
> I'm experimenting with the dosing of my gabapentin, but usually, it should be taken three times daily.
>
> So adding gabapentin might be an option.
>Hey there-
Neurontin seems like a good option for many, and I used to take it, but it made me manic. Weird, huh? It's used as a mood stabilizer, so my response was paradoxical, but I've seen other people with similar responses report this online.
Otherwise, it can be helpful at elevating mood (quickly, within a few hours), with anxiety and with sleep. I think I initially liked it because it elevated my mood so quickly, enabling me to get out of bed, leave the apartment and actually interact with people. Unfortunately, it made me way too elevated, even at the lowest doses.
-B
Posted by Brainbeard on July 31, 2012, at 15:35:17
In reply to Re: Gabapentin (Neurontin) » Brainbeard, posted by brynb on July 31, 2012, at 9:53:10
That's interesting. In fact, it's the mania I'm after. I use to call it 'hypomania' (Greek 'hypo' means 'below'; also: 'below manic', as in 'almost manic' or 'close to being manic') - I'm not truly bipolar in the DSM-IV understanding of the word, and my desired state is not truly manic, but it has, to a lesser extent, all the characteristics of her grotesque sister.
It is my theory that SSRIs work precisely because they make people hypomanic. Hypomania can, in contrast with true mania, be implemented in real life and it can be used as a source of energy and motivation, as well as euphoria, mild though it may be.
Posted by brynb on July 31, 2012, at 18:55:07
In reply to Gabapentinized Rope Walker, posted by Brainbeard on July 31, 2012, at 15:35:17
> That's interesting. In fact, it's the mania I'm after. I use to call it 'hypomania' (Greek 'hypo' means 'below'; also: 'below manic', as in 'almost manic' or 'close to being manic') - I'm not truly bipolar in the DSM-IV understanding of the word, and my desired state is not truly manic, but it has, to a lesser extent, all the characteristics of her grotesque sister.
>That sounds a lot like me. I'm currently (diagnostically) being treated for MDD (my label for years, though it's been suggested on several occasions that I have bipolar 2). I also don't fall under the DSM's characterization of bipolar, but am more consistent with the newer understanding of bipolar and mood disorders as existing on a continuum. (The DSM, IMHO, is a lofty albeit often misguided and archaic attempt to categorize that which can't be.)
Until Neurontin, "mania" for me had been irritability, anxiety, severe swings, etc. At first, Neurontin gave me that hypomania (and euphoria) we depressives seek. But over the past year, it made me completely manic (at least my understanding of it). I was talking a mile a minute, euphoric (high!), had uncontrollable crying fits and racing thoughts that couldn't come out fast enough. Not fun (really scary, in fact). So it's obviously out for me.
> It is my theory that SSRIs work precisely because they make people hypomanic. Hypomania can, in contrast with true mania, be implemented in real life and it can be used as a source of energy and motivation, as well as euphoria, mild though it may be.
>Interesting theory. I've always done well on Lexapro (except it doesn't prevent depressive episodes and inevitably poops out). Serotonin seems to be the key neurotransmitter for me. I also take a low dose of Lithium (which, so far, is working great) as well as a low dose of Tramadol (it's SNRI and opioid properties are perfect for me--anything stronger, like a true NRI, is too much for me). I guess there's a fine line between hitting "baseline" or going a bit above that and experiencing hypomania. But if surpassing baseline to a controllable level means being able to predict my mood, functioning, socializing and even being (dare I say!) happy, I'll take it ;).
-b
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