Psycho-Babble Medication Thread 1110189

Shown: posts 1 to 11 of 11. This is the beginning of the thread.

 

Fluoxetine (Prozac) vs Fluvoxamine (Luvox)

Posted by tensor on May 17, 2020, at 6:29:47

Hello,

I suffer from MDD, anxiety/panic disorder and social phobia. My depression got so bad a few years ago that I was no longer able to work even part time, I still do not work and I receive disability pension.
Currently on following meds:
Escitalopram 20mg (anxiety)
Mirtazapine 7.5mg (for sexual dysfunction)
Lamictal 75mg (depression)
Nortriptyline 25 mg (depression)
Clonazepam 2mg (social phobia)
Melatonin 3mg (sleep)
Oxazepam 30mg prn (sleep/anxiety)

I use low doses for depression because higher doses only yield stronger side effects, I never remit from depression anymore and the best I can get and what I aim for is that I'm in a good mood and that I can enjoy my hobbies a few hours a few times a week.
The problem right now is increasing anxiety, for several years escitalopram kept my anxiety manageable, but last year I noticed I kept getting more anxiety attacks and I often feel a knot in my stomach. Now I can't sleep at other places than at home, this limits my life in a way that is not acceptable, I do wildlife photography and sometimes you want to go to places that are too far away that sleeping at home is not feasible.
I get panicky when too far away from home and my anxiety level makes it impossible to enjoy whatever activity I intended to do.

My pdoc is not comfortable raising the dosage of escitalopram above 20mg. So my idea is to switch to another SSRI, 50mg of sertraline was once great against my depression but stopped working and higher doses gave me akathisia while remaining ineffective for my depression. I didn't like paroxetine for reasons I can't remember, it was so long ago.
Fluoxetine was the first antidepressant I ever tried, while not effective for my depression, I remember it had a good effect on my anxiety, pretty bad sexual side effects but I don't worry too much about that now. Back then I ended up with a combo of fluoxetine + mirtazapine, the latter was like a miracle drug for my depression.
So fluoxetine seems like a good candidate, but since I last took it, it has been twenty years and maybe 35 different medications, hard to say if I would respond similarly today.
Never tried fluvoxamine, looks interesting but a lot of interactions. I think I would have to drop nortriptyline due to interactions which is okay, it's more of a "legacy" medication at this point. I think the rest of my medications would be okay.

So what do you think, what are your experiences with these two medications for anxiety disorders? Any other ideas welcome, of course.

Thanks,
tensor

 

Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox)

Posted by rjlockhart37 on May 17, 2020, at 11:52:08

In reply to Fluoxetine (Prozac) vs Fluvoxamine (Luvox), posted by tensor on May 17, 2020, at 6:29:47

fluoxetine is more stimulating, much more than luvox. Luvox is for bad anxiety, and severe OCD. Pro hits norephirnpine receptors, which is why its a bit activting, luvox is a potent serotonin med. That's one the reasons why its sedating, but it be calming, relief from OCD

 

Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox)

Posted by linkadge on May 17, 2020, at 17:44:06

In reply to Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox), posted by rjlockhart37 on May 17, 2020, at 11:52:08

You probably don't have to drop nortriptyline, but just be aware that fluvoxamine can alter the blood level. If you're keen on keeping nortriptyline, you could get a blood test before and after fluvoxamine to monitor the blood level. You may just need to adjust the dose of nortriptyline downwards.

Fluvoxamine can be good for anxiety and sleep.

Linkadge

 

Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox)

Posted by tensor on May 17, 2020, at 18:15:41

In reply to Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox), posted by linkadge on May 17, 2020, at 17:44:06

Thanks, I have read through your replies and I'm afraid Luvox will make me sleepy and I already spend way too much time in the bed. Fluoxetine could interfere with nortrip and clonazepam, do you think it could be a problem? I do want to keep the nortrip, but any higher dosage/blood level makes me grumpy and gives me unpleasant side effects.
Checking blood levels of nortrip is a fairly long process, I have done it once and the blood sample has to be sent to another lab. I don't want to be a burden now under the corona crisis.
I have a doctor appt on Wednesday and I think I'm going to ask for fluoxetine.

/tensor

 

Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox)

Posted by linkadge on May 18, 2020, at 8:24:10

In reply to Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox), posted by tensor on May 17, 2020, at 18:15:41

Some interactions just mean there may need to be a dose adjustment. You can slowly introduce a new agent and watch for side effects. Fluoxetine can increase the levels of nortriptyline, but it doesn't necessarily mean you need to stop nortriptyline altogether. If you know how too much nortriptyline feels, then you could reduce the dose, if needed.

Alternatively, you could temporarily stop nortriptyline and introduce fluoxetine. Then you could slowly reintroduce nortriptyline (from 0mg upwards) until you notice the effect you're looking for. That way your nortriptyline levels are less likely to spike.


Linkadge

 

Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox) tensor

Posted by ed_uk2010 on June 5, 2020, at 12:43:34

In reply to Fluoxetine (Prozac) vs Fluvoxamine (Luvox), posted by tensor on May 17, 2020, at 6:29:47

Hi M,

Nice to see your post. Sorry to hear things aren't too good.

Although it's not something you mentioned....

Potentially, I'd consider:

1. Tapering and stopping nortriptyline over a few weeks.
2. Cross-tapering off escitalopram and over to venlafaxine. Increasing venlafaxine from 75mg/day up to 150mg-225mg fairly rapidly, then increasing to 300-375mg in future if necessary.

Venlafaxine has efficacy in both anxiety and depression over a very wide dose range, which is potentially useful for those with treatment-resistance.

I recall that you experienced uro-gential adverse effects previously, due to NRIs with unopposed alpha blockade. Although these are usually minor with the SNRI venlafaxine in comparison with the likes of reboxetine, it would be possible to remedy them if necessary with a low dose of an alpha blocker, such as doxazosin 1mg at night. I would avoid tamsulosin for this purpose, since it tends to impair ejaculation.

What do you think?

 

Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox) ed_uk2010

Posted by tensor on June 5, 2020, at 13:43:38

In reply to Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox) tensor, posted by ed_uk2010 on June 5, 2020, at 12:43:34

Hi Ed, it's been a while :)

It's been a couple of rough weeks, especially anxiety-wise, I went with fluoxetine and now I'm at 20mg. Will take a while to assess each dosage due to its long half-life. Kind of okay energy-wise, relatively speaking that is, only enough for some photography a few times a week, but I have accepted it and have managed to embrace my depression and the life-style that follows with it.
No I haven't mentioned it anywhere, it's one of those setbacks that come and go, I'm so used to it that I normally just ride it out without changing medications, however, the anxiety level started to rise about a year ago, it's like escitalopram just isn't (wasn't) cutting it anymore, 30mg could possibly have fixed it but the cardiac side effects prohibits dose increase and my doctor won't allow it.
I was thinking of venlafaxine, but my prior experience is night-time sweating, and not lightly either, but the sheets completely soaked, I remember having to put towels in the bed when I woke up in the night just to let me finish my sleep.
I opted for fluoxetine because it had such a nice anxiolytic effect back in the days, I really only quit it because I couldn't perform optimally in bed, which was a big deal back then :D
Currently, my brain zaps from messing with serotonin have finally reduced to a point that it doesn't interfere with whatever I'm doing. My doctor will call me on Monday. I only take 12.5mg of nortriptyline since I was afraid it would increase in the blood, my doctor insisted that any downward dose adjustment was unwarranted and that I should stay on 25mg. I brought up the enzyme problem but said it wouldn't be a problem. She may be right, I don't know, but I want to be cautious. If I start to feel grumpy I will just drop it.

Thanks for your message, how's life treating you? :)

Best,
M

> Hi M,
>
> Nice to see your post. Sorry to hear things aren't too good.
>
> Although it's not something you mentioned....
>
> Potentially, I'd consider:
>
> 1. Tapering and stopping nortriptyline over a few weeks.
> 2. Cross-tapering off escitalopram and over to venlafaxine. Increasing venlafaxine from 75mg/day up to 150mg-225mg fairly rapidly, then increasing to 300-375mg in future if necessary.
>
> Venlafaxine has efficacy in both anxiety and depression over a very wide dose range, which is potentially useful for those with treatment-resistance.
>
> I recall that you experienced uro-gential adverse effects previously, due to NRIs with unopposed alpha blockade. Although these are usually minor with the SNRI venlafaxine in comparison with the likes of reboxetine, it would be possible to remedy them if necessary with a low dose of an alpha blocker, such as doxazosin 1mg at night. I would avoid tamsulosin for this purpose, since it tends to impair ejaculation.
>
> What do you think?
>
>

 

Thank you! (nm) linkadge

Posted by tensor on June 5, 2020, at 13:45:05

In reply to Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox), posted by linkadge on May 18, 2020, at 8:24:10

 

Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox) tensor

Posted by ed_uk2010 on June 5, 2020, at 13:53:53

In reply to Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox) ed_uk2010, posted by tensor on June 5, 2020, at 13:43:38

Hi M,

Nice to hear from you too. Life isn't treating me too badly, thanks. Nothing particularly exciting to report though. It's the first time I've been on p-babble in ages.

I'm curious that your doctor would allow you to take nortriptyline in combination with escitalopram, but not a higher dose of escitalopram alone. Both would seem to have similar risk RE the QTC. In reality, the risk to those with structurally normal hearts is probably very low, but doctors practice with caution... they know the legal implications if something goes wrong and they haven't followed the manufacturer's advice. The manufacturer does advise not to use it in combination with TCAs though!

I really hope fluoxetine works out for you. If not, you might find that venlafaxine proves more tolerable this time. It often works like that... with the passage of time and taken in combination with different meds, the side effects (and efficacy) of a med can change remarkably!

I think you're right to half the nortrip, to be honest, it sounds sensibly cautious, especially if you've previously had side effects on higher doses.

 

Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox) ed_uk2010

Posted by tensor on June 5, 2020, at 14:22:24

In reply to Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox) tensor, posted by ed_uk2010 on June 5, 2020, at 13:53:53

> Hi M,
>
> Nice to hear from you too. Life isn't treating me too badly, thanks. Nothing particularly exciting to report though. It's the first time I've been on p-babble in ages.
>
> I'm curious that your doctor would allow you to take nortriptyline in combination with escitalopram, but not a higher dose of escitalopram alone. Both would seem to have similar risk RE the QTC. In reality, the risk to those with structurally normal hearts is probably very low, but doctors practice with caution... they know the legal implications if something goes wrong and they haven't followed the manufacturer's advice. The manufacturer does advise not to use it in combination with TCAs though!
>
> I really hope fluoxetine works out for you. If not, you might find that venlafaxine proves more tolerable this time. It often works like that... with the passage of time and taken in combination with different meds, the side effects (and efficacy) of a med can change remarkably!
>
> I think you're right to half the nortrip, to be honest, it sounds sensibly cautious, especially if you've previously had side effects on higher doses.

It's really great to hear your life is going great for you, I can't really complain either, there's so much horrible things going on in the world with people suffering hell every minute of the day. I really have all I need.

The thing is, she kind of inherited my medication list, I got this new female doctor a couple of years ago when my all-time fav doctor retired. While this new (new to me) is experienced and all she isn't nearly as chill as my previous doc and is rather formal in most regards, but listens to me and generally agrees with most of my ideas. Like for example, this switch from escitalopram to fluoxetine had to be done with a taper, first 10mg esc for one week, stop esc and then start flu at 10mg for one week, although in practice I cut corners a bit :D I have feeling my old doc would have made this switch a lot quicker if not instant, I really don't think there would be any problem to swap 20 esc for 20mg flu, but due to my anxious nature I (almost) followed my doc's advise.
You're of course right in that meds can change the way they treat you over time, so much stuff has happened since last time, that if I were to restart venlafaxine it probably wouldn't recognize my brain. I really focus a lot less on meds now than I used to, if I find a combination that manage to find the right balance between anxiety and not being too sedated/tired, it's good enough. Being anxiety free AND having energy is a big no-no :)

M

 

Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox) tensor

Posted by ed_uk2010 on June 11, 2020, at 13:38:59

In reply to Re: Fluoxetine (Prozac) vs Fluvoxamine (Luvox) ed_uk2010, posted by tensor on June 5, 2020, at 14:22:24

Well.... I must say I'm glad that you'd consider giving venlafaxine another go. It's not a first line antidepressant, as you know, but it does often have a role when SSRIs haven't been adequate.

If you don't think nortriptyline is helping much, and your current SSRI isn't adequate, it might be worth withdrawing both and titrating up on venla. It's hardly likely to be a miracle, but it could be more effective than an SSRI, and therefore worth the switch.

Do let me know what you decide. The fact that switching to venlafaxine could reduce the total number of meds being taken might appeal to your pdoc, by the sound of it!


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