![[dr. bob]](/dr-bob-sm.gif)
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 Rahilka on October 19, 2013, at 23:58:21
Hey everyone!
As of five days ago, I am on fluvoxamine (sorry if that is spelled incorrectly, I just took a sleeping tablet and feel pretty loopy,) for depression, GAD, OCD, and SAD. I started off on a very low 25 milligrams for two days before moving up to 50 milligrams for the past three days. From my understanding, the lowest effective dose should be 100 milligrams and I requested my doctor to raise me up more quickly but he denied my request since I have a tendency to be very reactive (physically and emotionally,) to side effects. I can usually tell how an SSRI is going to affect me within a week of starting one since I have now officially tried all of the SSRIs (yay me!) and so far on the Luvox I am feeling very listless, highly apathetic, there has been no help with my lethargy (if anything it's made my lethargy worse,) and a disturbing lack of motivation. I don't think that I an attribute all of these symptoms to my depression - they did exist to some extent (except for the motivation and apathy) prior to commencing Luvox but have since intensified 10x. I know that SSRIs are generally known for causing some apathy, and I think in some ways that is beneficial FOR ME since I tend to care way too much about unimportant things and am very neurotic by nature. So yay for decreasing a lot of my anxiety! However, THIS particular feeling of apathy is so strong it is hard to get out of bed in the morning and not because I am feeling depressed. Not to mention I am experiencing some pretty hardcore drowsiness and I am not even on a therapeutic dose yet!
ANYWAY, I can't judge the efficacy of the medication yet obviously, but if these side effects stick around I plan on augmenting my SSRI with another med to help with motivation, pleasure, drive, interest, and energy.
I have seen people augment SSRIs with Wellbutrin - the NDRI which supposedly has a much, much higher affinity for NE than dopamine (is this true?) However, I was wanting to look up some other possible strategies. Does anyone have any suggestions? If you name a suggestion, will you tell me why? Not only for my own medication's sake but also because ever since I have jumped onto the "med-go-round" I have become FASCINATED by psychopharmacology! I am in my early 20s and was thinking of maybe down the road doing something in psychiatry once I got myself straightened out. Of course I don't think this will ever happen but it's nice to just entertain the thought.
Thanks everyone.
Posted by joef on October 20, 2013, at 7:12:33
In reply to Augmenting Luvox/SSRIs in general...I'm a newbie!, posted by Rahilka on October 19, 2013, at 23:58:21
luvox seems to hardly be used any more...hardly anyone on this post besides phillipa uses it ...ask your dr. if maybe you can get your results with another ssri..only a thought
Posted by Christ_empowered on October 20, 2013, at 9:59:44
In reply to Re: Augmenting Luvox/SSRIs in general...I'm a newbie!, posted by joef on October 20, 2013, at 7:12:33
Ritalin/Focalin?
Posted by Phillipa on October 20, 2013, at 9:59:59
In reply to Re: Augmenting Luvox/SSRIs in general...I'm a newbie!, posted by joef on October 20, 2013, at 7:12:33
Yes Joe is correct. I seem to be the only person who still takes this med. But I only take 25mg of it. Why? I feel I've been on ad's for too long and it's up to me to do the rest of the work. But I must add that when first took luvox I took 250mg with benzos and felt great. Never apathy for me. Phillipa
Posted by joef on October 20, 2013, at 11:18:33
In reply to Re: Augmenting Luvox/SSRIs in general...I'm a newbie!, posted by Phillipa on October 20, 2013, at 9:59:59
does anyone think this is a really strange drug?
Posted by linkadge on October 20, 2013, at 16:15:38
In reply to Re: Augmenting Luvox/SSRIs in general...I'm a newbie!, posted by joef on October 20, 2013, at 11:18:33
Actually, I think that luvox is one of the more effective SSRIS out there.
I would give it more time. If you have only been on it a few days, I would give it at least a month or two before starting any form of augmentation.
Linkadge
Posted by jono_in_adelaide on October 20, 2013, at 21:22:03
In reply to Re: Augmenting Luvox/SSRIs in general...I'm a newbie!, posted by linkadge on October 20, 2013, at 16:15:38
I'd suggest adding Welbutrin (bupropion) 300mg in the morning for the depression, liastlesness, anhedonia etc
You could also add Atarax (hydroxyzine) 25-50mg 3 times a day for anxiety type symptoms
Posted by Rahilka on October 21, 2013, at 11:27:30
In reply to Re: Augmenting Luvox/SSRIs in general...I'm a newbie!, posted by jono_in_adelaide on October 20, 2013, at 21:22:03
Thanks to everyone for your replies!
JoeF I have tried all of the other SSRIs and the one I was on the longest was Zoloft which I took for 8 years. I have tried two other times to go back on it and even at 12.5 mg it is so stimulating I cant keep still and it makes me feel absolutely insane. I could only hold on for a week the last time I tried to get on it. I dont know why it is so intolerable all of a sudden and I really wish it wouldnt give me such a hard time; it helped so much with my attention issues and brain fog :( Maybe the horrible anxiety would go away if I just stayed on it longer?
Also, what do you mean about Luvox being a strange drug? Is it that different than the other SSRIs?
Christ Empowered I have never heard of Focalin, but Ritalin I think might be a bad idea for me personally since ADD/ADHD medications make me so irritable. Of course, this could be different once I am fully ramped up on an antidepressant which prevents the anxiety
Phillipa I am so happy to hear that Luvox helped you so much and for so long! May I ask what you started taking it for? I have MDD, GAD, SAD, OCD, and BDD, and am essentially afraid of the world. I go to therapy too and I dont know if I dont express myself well enough or if my therapist doesnt think I am as bad as I am but we have had minimal results from it and I have been going since February of this year :/
Linkadge Thanks for commenting that Luvox is one of the most effective SSRIs. That made me feel better since today has already been really bad and its only 12:15 in the afternoon. Have you taken Luvox before? Why do you think it is so effective compared to the other SSRIs? I am worried that it is going to make me lazy and tired all the time.
Jono_in_Adelaide Thanks so much for the suggestions! When I see my doctor next after I am on a sufficient dose of this medicine I will ask about the Wellbutrin and the Atarax (never heard of the last one.)
Updatestill on 50 milligrams, I went to a friends house last night and although I felt less socially inhibited I also felt extremely ADD and distracted, I had trouble sitting still, paying attention, and my thoughts were racing really fast just like they are now. This med is definitely increasing my overall feeling of anxiety and making me feel forgetful and stupid. Then I got home and had nightmares all night, couldnt stop obsessing about this particular thing that is going on in my life right now (still cant stop getting the intrusive thoughts and am thinking of taking a klonopin,) and woke up jittery, heart pounding, and feeling extremely depressed and hopeless.
:(
Posted by joef on October 21, 2013, at 12:01:31
In reply to Reply to all, posted by Rahilka on October 21, 2013, at 11:27:30
all I mean is it interact with so many different things...its dosing range is very wide...and the caffeine issue,,,,well ask your dr. about that
Posted by Phillipa on October 21, 2013, at 20:56:11
In reply to Reply to all, posted by Rahilka on October 21, 2013, at 11:27:30
Honestly I have no idea why it worked so well for me as many don't like this med. All I know is was started on it in a hospital setting many years ago. First night given 50mg and sat there waiting for side effects felt none. Now I was also on Ativan. The next morning the doc upped me another 50mg still nothing and kept on the Ativan, till I reached 250mg. I felt good. When lymes disease was discovered I had to lower the doseage and have just kept it low. I once said to a doc I guess my brain needs luvox. But now only 25mg. And the actual dose now could be higher as now it's Xanax and valium I take also. True what Joe said luvox potentiates the effects of many drugs and they say coffee is absolutely horrible so if drink it you need to stop it. And then maybe luvox isn't the med your brain needs. Was given to me for OCD not bad just counted in head and anxiety. Phillipa
Posted by Rahilka on October 21, 2013, at 22:57:53
In reply to Re: Reply to all » Rahilka, posted by Phillipa on October 21, 2013, at 20:56:11
Oh yes - the other drug interactions, caffeine/nicotine (?) potentiation, it's effect on certain benzos, etc. I definitely read up on those before I started the Luvox. Phillipa I am glad that it has given you so many years of feeling good! I really hope it does the same for me.
I do drink one cup of coffee in the morning, and usually just a half a cup anyway. Is this harmful? Also, I do smoke on occasion, I'd say less than a pack a week.
Today has been horrible awful atrocious. Whenever I try to get up and get things done my body just feels so tired and I get so dizzy and I have to lay back down. I'm so, so depressed. I don't know how I am going to make it through the rest of this trial and I have no idea what I will do if this med doesn't work out. I can't stand this lethargy. Effexor did the same thing to me - I was told it would be stimulating but it was the most sedating medication I have ever taken and it made my depression worse and I was essentially bedridden for a month and a half.
When you guys are put on a medication, what do you do in the meantime while you are waiting for it to kick in? I don't have many friends out here, and the ones I do have I would never talk about my mental illnesses with. Plus I have social anxiety so hanging out becomes too painful afterwards - I run through the entire conversation a million times in my head and obsess over everything that was said. I am not really able to work at all. I have no energy although I try to take my dog for a decent walk every day. Nothing interests me because I am so depressed.
How does everyone else get through this?
Posted by doxogenic boy on October 22, 2013, at 15:36:10
In reply to Augmenting Luvox/SSRIs in general...I'm a newbie!, posted by Rahilka on October 19, 2013, at 23:58:21
Maybe you could try add an atypical antipsychotic? I often recommend Seroquel (at bedtime) for those who have anxiety and don't get better with an SSRI alone.
I hope you find something that works.
- doxogenic
Posted by Rahilka on October 22, 2013, at 21:47:59
In reply to Re: Augmenting Luvox/SSRIs in general...I'm a newbie! » Rahilka, posted by doxogenic boy on October 22, 2013, at 15:36:10
> Maybe you could try add an atypical antipsychotic? I often recommend Seroquel (at bedtime) for those who have anxiety and don't get better with an SSRI alone.
>
> I hope you find something that works.
>
> - doxogenicThanks for the suggestion, Doxogenic! When I was hospitalized I was given a really low dose of Seroquel at night (25 mg) for insomnia. For that, it was absolutely amazing.
I wonder though if it would make me feel even more sedated on the Luvox since it is already so tranquilizing...?
Update: Tomorrow I have to go into work and I have felt SO STUPID all of today and yesterday and highly depressed. This is dreadful. I was so close to calling my doctor today but I know all he is going to say is "stay on it or get off the med." I think he is sick of me!
My friend called me tonight and the whole time he was talking I had such horrid trouble trying to follow what he was saying, and I can hardly formulate a sentence. My brain feels like apple sauce...I hope this mental lethargy goes away on a higher dose even though I have to wait THREE WEEKS just to go up! I think my doctor may be titrating me up on meds wayyyy too slowly...
Posted by doxogenic boy on October 23, 2013, at 3:24:08
In reply to Re: Augmenting Luvox/SSRIs in general...I'm a newbie!, posted by Rahilka on October 22, 2013, at 21:47:59
> Thanks for the suggestion, Doxogenic! When I was hospitalized I was given a really low dose of Seroquel at night (25 mg) for insomnia. For that, it was absolutely amazing.
>
> I wonder though if it would make me feel even more sedated on the Luvox since it is already so tranquilizing...?That could happen, but it is difficult to say. Since you have GAD, OCD and SAD, stimulating antidepressants could worsen your anxiety. Seroquel can help for treatment-resistant depression in combination with SSRIs.
Here is a study showing that an antypical antipsychotic works against SSRI-induced apathy. It is about long-term use of SSRIs, though.
http://www.ncbi.nlm.nih.gov/pubmed/12019662
Excerpt from the abstract above:J Clin Psychiatry. 2002 May;63(5):391-5.
Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study.
Marangell LB, Johnson CR, Kertz B, Zboyan HA, Martinez JM.
SourceMood Disorders Center, Department of Psychiatry, Baylor College of Medicine, Houston, Tex 77030, USA. laurenm@bcm.tmc.edu
Abstract
BACKGROUND:We report a clinical trial of olanzapine in the treatment of prominent apathy in the absence of depression in patients on long-term treatment with selective serotonin reuptake inhibitors (SSRIs) for nonpsychotic major depression.
[...]
CONCLUSION:These preliminary data suggest that olanzapine may be effective in treating apathy syndrome in nonpsychotic patients taking SSRIs.
End quote.>I hope this mental lethargy goes away on a higher dose even though I have to wait THREE WEEKS just to go up! I think my doctor may be titrating me up on meds wayyyy too slowly...
Some Luvox users can get nausea and vomiting if they titrate too fast and start with a high dose. Maybe this is a reason why your doctor is titrating you so slow.
Seroquel (quetiapine) can work for sleep quality in GAD:
http://www.ncbi.nlm.nih.gov/pubmed/24135509
Quote from the link above:
J Affect Disord. 2013 Aug 16. pii: S0165-0327(13)00608-3. doi: 10.1016/j.jad.2013.07.037. [Epub ahead of print]
Effects of extended-release quetiapine fumarate on long-term functioning and sleep quality in patients with Generalized Anxiety Disorder (GAD): Data from a randomized-withdrawal, placebo-controlled maintenance study.
Sheehan DV, Svedsäter H, Locklear JC, Eriksson H.
SourceUniversity of South Florida College of Medicine, Tampa, FL 33613, USA. Electronic address: dsheehan@health.usf.edu.
Abstract
BACKGROUND:This analysis evaluated effects of quetiapine XR maintenance treatment on functioning and sleep in patients with GAD.
[...]CONCLUSIONS:
In patients with GAD, long-term treatment with quetiapine XR (50-300mg/day) monotherapy was effective at maintaining improvements in functioning and sleep quality.
End quote.- doxogenic
Posted by former poster on October 29, 2013, at 9:18:44
In reply to Augmenting Luvox/SSRIs in general...I'm a newbie!, posted by Rahilka on October 19, 2013, at 23:58:21
Welcome new Babbler.
I think Luvox is one of the best SSRI's I have tried. Especially good for anxiety. I stopped taking it years ago because of sexual side effects. I was taking it with the dopamine agonist "Pemoline" (no longer available) . This combination was effective for social anxiety.Possible combination with bupropion might be beneficial.
Posted by SLS on November 6, 2013, at 14:23:48
In reply to Re: Augmenting Luvox/SSRIs in general...I'm a newbie! » Rahilka, posted by doxogenic boy on October 22, 2013, at 15:36:10
> Maybe you could try add an atypical antipsychotic? I often recommend Seroquel (at bedtime) for those who have anxiety and don't get better with an SSRI alone.
That's an interesting strategy. It makes sense. Is there a dosage range for Seroquel that you feel is optimal?
- Scott
Posted by doxogenic boy on November 6, 2013, at 16:58:39
In reply to Re: Augmenting Luvox/SSRIs in general...I'm a newbie! » doxogenic boy, posted by SLS on November 6, 2013, at 14:23:48
> > Maybe you could try add an atypical antipsychotic? I often recommend Seroquel (at bedtime) for those who have anxiety and don't get better with an SSRI alone.
>
> That's an interesting strategy. It makes sense. Is there a dosage range for Seroquel that you feel is optimal?I use 600 mg Seroquel at bedtime, but I have a friend who uses 50 mg for sleep, and this is enough for him to prolong his sleep. If he takes more than that, he get akathisia, which make it difficult for him to sleep. He even get akathisia at night on 50 mg, if it takes too long time from he takes his 50 mg Seroquel until he falls asleep.
I don't know what dosage range is optimal, but I think one should keep the dosage at a level that doesn't give too unpleasant side effects. If it is only for sleep, it may be enough with 50 mg, but I think higher dosages are necessary for reaching antidepressant effects.
- doxogenic
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.