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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by FloydAS on August 19, 2015, at 11:48:35
Following several years of several dosage levels of Zoloft up to 200 mg max to deal with diagnosed generalized anxiety disorder, I went on about a 6 month SSRI hiatus.
In the interim, I've been on 50 mg twice a day of Topamax for migraine/headache treatment (quite successful with minimal side effects, including no real weight loss), 40 mg propranolol twice a day for essential tremor, xanax xr 0.5 mg up to twice a day as needed, focalin xr 10 mg once a day as needed for ADD.
That being said, my pdoc prescribed Brintellix 5 mg back in April 2015 due to treatment resistant anxiety disorder. The first two-three weeks were outstanding. Initial nausea side effects resolved relatively quickly. The best result was my mood was significantly elevated and I experienced levels of happiness and ability to be outgoing that I hadn't experienced in well over a decade. I was SO excited.
The initial bump I got from a mood and social/out-going standpoint leveled off after about 2-3 weeks. My dosage was increased to 10 mg at that time with no real difference in results. Side effects returned briefly.
My dosage was again increased to 20 mg this month (august) following a discussion on the above regarding the initial positive reaction and subsequent leveling off of effects. I've been on 20 mg for a week now. I would say I'm experiencing marginal benefits of the increased dosage to 20 mg.
The most impactful benefits included a significant reduction of the use of the xanax xr. Where I was taking the xanax xr for serious anxiety and panic issues to the tune of 30+ pills per month, I'm now going 2+ months without the need for a refill. This is a huge improvement. Also, there is a significant cognitive improvement as well - similarly my use of Focalin XR has been reduced by about half.
My only disappointment was the tease of the mood elevation during the initial two weeks. It appears I won't achieve that "happy state" again and for that I'm fairly disappointed and wonder if I have a bout of depression or other issue that is undiagnosed or if I should just forget about it altogether. The way I will put it, is that I felt myself during those two weeks and comfortable within my skin for the first time in a very long time and sad that it was so fleeting.
Posted by SLS on August 19, 2015, at 14:01:41
In reply to My Brintellix Experience, posted by FloydAS on August 19, 2015, at 11:48:35
Phidippus (Eric) has posted that he gets quite a bit of an improvement when taking 40 mg/day of Brintellix. However, this dosage is not described in the official manufacturer's label. Although it might be perfectly safe to take at the elevated dosages, I doubt your doctor would risk trying it.
From Brintellix label:
"10.1 Human Experience
There is limited clinical trial experience regarding human overdosage with BRINTELLIX. In pre-
marketing clinical studies, cases of overdose were limited to patients who accidentally or
intentionally consumed up to a maximum dose of 40 mg of BRINTELLIX. The maximum single
dose tested was 75 mg in men. Ingestion of BRINTELLIX in the dose range of 40 to 75 mg
was associated with increased rates of nausea, dizziness, diarrhea, abdominal discomfort,
generalized pruritus, somnolence, and flushing."I hope you experience the re-emergence of therapeutic effect. It might take another 2-3 weeks to have this happen at the higher dosage.
Good luck.
- Scott
Posted by phidippus on August 19, 2015, at 22:05:11
In reply to My Brintellix Experience, posted by FloydAS on August 19, 2015, at 11:48:35
I take 40 mg of Brintellix and have experienced a sustained boost in my mood-my ocd has gone into remission as well and I hardly have any anxiety or panic symptoms. The way Brintellix works seems to make it better for anxiety than for depression. It antagonizes a lot of receptors that deal with anxiety.
What sort of depressive symptoms are you having?
Eric
Posted by FloydAS on August 21, 2015, at 7:01:52
In reply to Re: My Brintellix Experience » FloydAS, posted by phidippus on August 19, 2015, at 22:05:11
> I take 40 mg of Brintellix and have experienced a sustained boost in my mood-my ocd has gone into remission as well and I hardly have any anxiety or panic symptoms. The way Brintellix works seems to make it better for anxiety than for depression. It antagonizes a lot of receptors that deal with anxiety.
>
> What sort of depressive symptoms are you having?
>
>
> EricFrom a depression standpoint, I can't say it is 100% depression as my pdoc has never actually diagnosed me with it - only anxiety issues. However when I was on my SSRI hiatus I fell into quite a stupor. I had extremely low energy, very low self-esteem, no real desire to do much of anything, took no pleasure in interacting with my family, looked forward to nothing, really enjoyed absolutely nothing. Day to day was frustrating simply due to the fact that there was no drive in me to look forward to anything - it was like the world stopped spinning and I was stuck in a serious rut. I took pleasure in nothing. I gained happiness from nothing. My mood was pretty much rock bottom.
I'm much better off now though. I wish I could stay at that elevated mood level peak but I could be satisfied staying at my leveled off mood that I'm at now. It's certainly better than where I started.
I have noticed weight gain that's been difficult to get under control since being on Brintellix - any similar issues for anyone here?? It could be related to other problems as I'm also having some congenital hip issues with both hips that required hip arthroscopy on one hip in late 2014 that I'm still recovering from and will need the same procedure on the other hip at the end of this year. That doesn't help any of my issues but I'm battling through it. This has certainly taken its toll on my ability to stay active and may be a source of the weight gain, but I'm not sure it is the sole source. Just trying to see if Brintellix may be part of it as well.
Thanks for all of the input...
Posted by phidippus on August 21, 2015, at 10:23:25
In reply to Re: My Brintellix Experience, posted by FloydAS on August 21, 2015, at 7:01:52
It is not uncommon to experience a positive bump in mood a couple of weeks into therapy with a new antidepressant. This is often an indication of a positive response to the medication. I am sorry though your 'bump' was not sustained and that you feel like you are settling for less-I am pretty convinced higher doses may return that feeling.
I've had no weight gain from Brintellix.
Are you taking any other medications?
Eric
Posted by FloydAS on August 21, 2015, at 13:21:53
In reply to Re: My Brintellix Experience » FloydAS, posted by phidippus on August 21, 2015, at 10:23:25
> It is not uncommon to experience a positive bump in mood a couple of weeks into therapy with a new antidepressant. This is often an indication of a positive response to the medication. I am sorry though your 'bump' was not sustained and that you feel like you are settling for less-I am pretty convinced higher doses may return that feeling.
>
> I've had no weight gain from Brintellix.
>
> Are you taking any other medications?
>
> EricUnfortunately, yes I am taking other medications.
Propranolol 40 mg twice a day for essential tremor; Topamax 50 mg twice a day for migraine prevention; nexium 40 mg once a day for reflux; mobic 15 mg once a day for hip issues; xanax xr 0.5 mg once to twice a day as needed (not taking this much lately); focalin xr 10 mg once a day as needed (taking this approximately 3-4 days a week).
The weight gain could possibly be a result of multiple corticosteroid injections for hip bursitis flare ups on both hips although my orthopedic doctor doesn't suspect it would cause weight gain (he did admit some patients do swear cortisone injections cause them weight gain but they don't have credible evidence that the injections are the cause). The timing would be about right as it was around the same time I started Brintellix so I thought I would ask here.
Posted by phidippus on August 21, 2015, at 15:17:33
In reply to Re: My Brintellix Experience, posted by FloydAS on August 21, 2015, at 13:21:53
How's your depression now?
Eric
Posted by FloydAS on August 21, 2015, at 17:24:56
In reply to Re: My Brintellix Experience » FloydAS, posted by phidippus on August 21, 2015, at 15:17:33
> How's your depression now?
>
> EricIt is certainly much improved as is my troubles with anxiety. It is difficult to totally evaluate effectiveness considering what I have been through with unexpected hip surgery at a young age and long rehab, not to mention staring the same surgery and rehab on the opposite hip just a year later. Not exactly an uplifting proposition.
I will have the unique experience of going through this second surgery and rehab while on Brintellix compared to the first when I was on hiatus from all AD medication. This procedure is a total life impacting experience as I am not allowed to be weight bearing on the operated leg for three solid weeks. That really messes with you mentally after some time. It will be interesting to see how much better I deal with all of it while on Brintellix because I had numerous breakdowns last time.
Posted by SLS on August 21, 2015, at 19:33:46
In reply to Re: My Brintellix Experience, posted by FloydAS on August 21, 2015, at 17:24:56
> It will be interesting to see how much better I deal with all of it while on Brintellix because I had numerous breakdowns last time.
I hope everything turns out well for you.
- Scott
Posted by phidippus on August 23, 2015, at 17:17:06
In reply to Re: My Brintellix Experience, posted by FloydAS on August 21, 2015, at 17:24:56
Hopefully the brintellix will help you with the mood and anxiety issues that go hand in hand with major medical procedures. 3 Weeks is a long time to be incapacitated.
What concerns do you have about coping? Do you have a PRN for breakthrough anxiety?
Eric
Posted by FloydAS on August 24, 2015, at 8:34:54
In reply to Re: My Brintellix Experience » FloydAS, posted by phidippus on August 23, 2015, at 17:17:06
> Hopefully the brintellix will help you with the mood and anxiety issues that go hand in hand with major medical procedures. 3 Weeks is a long time to be incapacitated.
>
> What concerns do you have about coping? Do you have a PRN for breakthrough anxiety?
>
> Eric
>Concerns with coping with the surgery and lengthy recovery specifically? That's easy - simply not being able to be independent and do anything on my own. I'll be on crutches for 4 weeks and mostly tied to a bed while recovering. I'll need assistance getting in and out of bed, in and out of the shower, in and out of the passenger seat of the car, not able to drive for two months, etc. It is quite disabling.
If you're speaking in more general terms, with regarding to coping concerns, I guess I have a lot of issues with self esteem rooted in my upbringing. I'm a product of a father who was very controlling, very angry, verbally abusive, very critical of even insignificant things. It has made me overly self conscious as an adult. I'm quite certain this is the root of most of my anxiety and depressive symptoms.
I don't have anything for breakthrough anxiety other than xanax xr which I do not take daily. I use it when I experience high levels of anxiety or near panic attacks.
Posted by phidippus on August 24, 2015, at 11:58:14
In reply to Re: My Brintellix Experience, posted by FloydAS on August 24, 2015, at 8:34:54
>I'm quite certain this is the root of most of my anxiety and depressive symptoms.
I wonder if your father had mood and anxiety issues.
I don't think your father's abuse is the root of your issues, but the effects of the abuse have combined with an existing organic issue to produce your current state.
I'm glad the Brintellix is working for you and hope your hip replacement goes well.
Eric
Posted by SLS on August 24, 2015, at 21:44:26
In reply to Re: My Brintellix Experience, posted by FloydAS on August 24, 2015, at 8:34:54
I hsd a similar upbringing as you did. There may be an element of PTSD (complex PTSD) involved in your anxiety and depression. I was incredulous when my doctor suggested prazosin. Still, I thought I'd throw him a bone and take the drug without protest. I was again incredulous when the drug actually worked! I take 30 mg/day. I divide the doses as 10 mg t.i.d. My only complaint is a big one. Prazosin knocks out my sex drive. However, the trade-off is worth it for me.
Although my response is only partial, I feel better with it than without it.
- Scott
Posted by former poster on August 25, 2015, at 13:22:34
In reply to Re: My Brintellix Experience, posted by FloydAS on August 21, 2015, at 17:24:56
>>This procedure is a total life impacting experience as I am not allowed to be weight bearing on the operated leg for three solid weeks.<<
I had a similar experience after retinal attachment surgery. I had to lay face down for 3 weeks as the gas bubble pushed the retina in place. I was almost psychotic after 1 week. Left home alone while my wife worked.
Doctors just want to fix you with no regard of other health issues.. He should have prescribed something similar to a massage table with hole for my face to look at a book or a mirror pointed at the TV.
This is the end of the thread.
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