Psycho-Babble Medication Thread 1119194

Shown: posts 1 to 13 of 13. This is the beginning of the thread.

 

Combining Prozac and Paxil....

Posted by PeterMartin on March 31, 2022, at 17:26:43

People don't do this. Why? Spinning off the 2 MAOIs at once thread...but....

 

Re: Combining Prozac and Paxil....

Posted by rjlockhart37 on March 31, 2022, at 18:55:27

In reply to Combining Prozac and Paxil...., posted by PeterMartin on March 31, 2022, at 17:26:43

maybe at low doses with titratrion, like prozac 40mg with a very low dose of paxil but mainly serotonin syndrome is danger of combining these two. Both SSRIs with remeron i've read has been done. Paxil and Prozac are dangerous combination with increase in serotonin. Yeah like 40mg of prozac and very low dose of paxil.

 

Re: Combining Prozac and Paxil....

Posted by rjlockhart37 on March 31, 2022, at 18:58:43

In reply to Re: Combining Prozac and Paxil...., posted by rjlockhart37 on March 31, 2022, at 18:55:27

my doctor just put me on 80ng of prozac, which is max. I don't understand really because 80mg of fluoxetine in serotonin levels, and then lowering prozac to a low dose and a very dose of paxil, i don't know if it would be dangerous, but i'm postive combing these two can cause serotonin syndrome. But let's wait for other posters they may know more....

 

Re: Combining Prozac and Paxil....

Posted by rjlockhart37 on March 31, 2022, at 19:15:33

In reply to Re: Combining Prozac and Paxil...., posted by rjlockhart37 on March 31, 2022, at 18:55:27

from what i'm reading from googling this, it said it would have CNS side effects of combination of fluoxetine and paroxetine

 

Re: Combining Prozac and Paxil.... PeterMartin

Posted by SLS on April 1, 2022, at 2:20:24

In reply to Combining Prozac and Paxil...., posted by PeterMartin on March 31, 2022, at 17:26:43

Hi.

> People don't do this. Why? Spinning off the 2 MAOIs at once thread...but....


If we were to ASSUME that there are several subtypes of the serotonin transporter, it may be that global serotonin potentiation can only be achieved by using one drug that binds to both subtypes or two separate drugs - one for each subtype configuration. Take into consideration that many drugs proposed to be used as augmenters of SSRIs for their multi-model actions at various serotonin receptors are themselves serotonin reuptake inibitors.

So, here we have a hypothetical rationale for taking two SRIs. I have very few insights into knowing what contraindications there are for the array of combinations of reuptake inhibitors.


- Scott

 

Re: Combining Prozac and Paxil.... PeterMartin

Posted by Jay2112 on April 3, 2022, at 19:13:52

In reply to Combining Prozac and Paxil...., posted by PeterMartin on March 31, 2022, at 17:26:43

> People don't do this. Why? Spinning off the 2 MAOIs at once thread...but....

Well, it is actually showing up in the research.
https://pubmed.ncbi.nlm.nih.gov/34728290/
This is with youth, but just type in combine ssri pubmed in google, and you will find a whole span.

My take, from actually combining Paxil and Prozac, was that is was good...to a point. Paxil has a mellowing anticholinergic action (not as strong, but similar to Elavil (Amitriptyline). Prozac also works on norepinephrine, and GABA. So...with a small dose of Paxil (5mg) and a regular dose of Prozac (20mg), I was able to get a bit more of a calming effect. But, the caveat, is that for some reason (maybe because of Paxil's stronger effect on serotonin) I developed some severe akathisia...inner restlessness. BUT, this was 15 or so years ago, and my dose of Prozac may have been much higher and/or the Paxil dose was higher.
It also could have been serotonin syndrome, so you do have to be careful. But, this is not unconventional territory.

Best,
Jay


 

Re: Combining Prozac and Paxil.... Jay2112

Posted by SLS on April 3, 2022, at 19:42:52

In reply to Re: Combining Prozac and Paxil.... PeterMartin, posted by Jay2112 on April 3, 2022, at 19:13:52

> > People don't do this. Why? Spinning off the 2 MAOIs at once thread...but....
>
> Well, it is actually showing up in the research.
> https://pubmed.ncbi.nlm.nih.gov/34728290/
> This is with youth, but just type in combine ssri pubmed in google, and you will find a whole span.
>
> My take, from actually combining Paxil and Prozac, was that is was good...to a point. Paxil has a mellowing anticholinergic action (not as strong, but similar to Elavil (Amitriptyline). Prozac also works on norepinephrine, and GABA. So...with a small dose of Paxil (5mg) and a regular dose of Prozac (20mg), I was able to get a bit more of a calming effect. But, the caveat, is that for some reason (maybe because of Paxil's stronger effect on serotonin) I developed some severe akathisia...inner restlessness. BUT, this was 15 or so years ago, and my dose of Prozac may have been much higher and/or the Paxil dose was higher.
> It also could have been serotonin syndrome, so you do have to be careful. But, this is not unconventional territory.
>
> Best,
> Jay
>

I think the title of the paper you cited is confusing. What the paper is about is combining one SSRI with cognitive-behavioral therapy. I may have missed something, though.

- Scott

 

Re: Combining Prozac and Paxil.... SLS

Posted by Jay2112 on April 3, 2022, at 20:46:46

In reply to Re: Combining Prozac and Paxil.... Jay2112, posted by SLS on April 3, 2022, at 19:42:52

> > > People don't do this. Why? Spinning off the 2 MAOIs at once thread...but....
> >
> > Well, it is actually showing up in the research.
> > https://pubmed.ncbi.nlm.nih.gov/34728290/
> > This is with youth, but just type in combine ssri pubmed in google, and you will find a whole span.
> >
> > My take, from actually combining Paxil and Prozac, was that is was good...to a point. Paxil has a mellowing anticholinergic action (not as strong, but similar to Elavil (Amitriptyline). Prozac also works on norepinephrine, and GABA. So...with a small dose of Paxil (5mg) and a regular dose of Prozac (20mg), I was able to get a bit more of a calming effect. But, the caveat, is that for some reason (maybe because of Paxil's stronger effect on serotonin) I developed some severe akathisia...inner restlessness. BUT, this was 15 or so years ago, and my dose of Prozac may have been much higher and/or the Paxil dose was higher.
> > It also could have been serotonin syndrome, so you do have to be careful. But, this is not unconventional territory.
> >
> > Best,
> > Jay
> >
>
>
>
> I think the title of the paper you cited is confusing. What the paper is about is combining one SSRI with cognitive-behavioral therapy. I may have missed something, though.
>
>
>
> - Scott

Oppps...sorry. I had bookmarked a few studies with SRI/SRI combos, but now when I need them, I can't find them..urrgghh..lol. Yes, the study I referenced was a CBT/SRI study.

But, my personal, subjective experience is only n=1, but I swear, I came across a few studies talking about both SRI/SRI and SNRI/SRI combos. One in particular, citalopram and venlafaxine, eased me right out of a horrid mixed episode.

Sorry...
Jay

 

Re: Combining Prozac and Paxil.... Jay2112

Posted by SLS on April 4, 2022, at 7:41:33

In reply to Re: Combining Prozac and Paxil.... SLS, posted by Jay2112 on April 3, 2022, at 20:46:46

> > > > People don't do this. Why? Spinning off the 2 MAOIs at once thread...but....
> > >
> > > Well, it is actually showing up in the research.
> > > https://pubmed.ncbi.nlm.nih.gov/34728290/
> > > This is with youth, but just type in combine ssri pubmed in google, and you will find a whole span.
> > >
> > > My take, from actually combining Paxil and Prozac, was that is was good...to a point. Paxil has a mellowing anticholinergic action (not as strong, but similar to Elavil (Amitriptyline). Prozac also works on norepinephrine, and GABA. So...with a small dose of Paxil (5mg) and a regular dose of Prozac (20mg), I was able to get a bit more of a calming effect. But, the caveat, is that for some reason (maybe because of Paxil's stronger effect on serotonin) I developed some severe akathisia...inner restlessness. BUT, this was 15 or so years ago, and my dose of Prozac may have been much higher and/or the Paxil dose was higher.
> > > It also could have been serotonin syndrome, so you do have to be careful. But, this is not unconventional territory.
> > >
> > > Best,
> > > Jay
> > >
> >
> >
> >
> > I think the title of the paper you cited is confusing. What the paper is about is combining one SSRI with cognitive-behavioral therapy. I may have missed something, though.
> >
> >
> >
> > - Scott
>
> Oppps...sorry. I had bookmarked a few studies with SRI/SRI combos, but now when I need them, I can't find them..urrgghh..lol. Yes, the study I referenced was a CBT/SRI study.
>
> But, my personal, subjective experience is only n=1, but I swear, I came across a few studies talking about both SRI/SRI and SNRI/SRI combos. One in particular, citalopram and venlafaxine, eased me right out of a horrid mixed episode.
>
> Sorry...


You ought to be!

<grin>


I found that my supposition regarding the possibility of there being subtypes of the serotonin transporter (SERT) has a factual basis.

"The human serotonin transporter gene (5-HTT) demonstrates two polymorphisms with possible functional impact: a 44-bp insertion/deletion polymorphism of the promoter region and a 17-bp variable number of tandem repeat polymorphism (VNTR) in intron 2 (STin2)."

https://www.nature.com/articles/4000821

I propose that two different serotonin transporters might need two different drugs (ligands) to block both of them robustly. Of course, one drug might be able to attach to both SERT subtypes equally.

For you, Jay, the question is whether or not venlafaxine and citalopram are each selective for a different serotonin transporter subtype. If so, that would explain your superior response to a combination of both drugs.


- Scott

 

Re: Combining Prozac and Paxil.... SLS

Posted by Jay2112 on April 8, 2022, at 22:35:25

In reply to Re: Combining Prozac and Paxil.... Jay2112, posted by SLS on April 4, 2022, at 7:41:33

> > > > > People don't do this. Why? Spinning off the 2 MAOIs at once thread...but....
> > > >
> > > > Well, it is actually showing up in the research.
> > > > https://pubmed.ncbi.nlm.nih.gov/34728290/
> > > > This is with youth, but just type in combine ssri pubmed in google, and you will find a whole span.
> > > >
> > > > My take, from actually combining Paxil and Prozac, was that is was good...to a point. Paxil has a mellowing anticholinergic action (not as strong, but similar to Elavil (Amitriptyline). Prozac also works on norepinephrine, and GABA. So...with a small dose of Paxil (5mg) and a regular dose of Prozac (20mg), I was able to get a bit more of a calming effect. But, the caveat, is that for some reason (maybe because of Paxil's stronger effect on serotonin) I developed some severe akathisia...inner restlessness. BUT, this was 15 or so years ago, and my dose of Prozac may have been much higher and/or the Paxil dose was higher.
> > > > It also could have been serotonin syndrome, so you do have to be careful. But, this is not unconventional territory.
> > > >
> > > > Best,
> > > > Jay
> > > >
> > >
> > >
> > >
> > > I think the title of the paper you cited is confusing. What the paper is about is combining one SSRI with cognitive-behavioral therapy. I may have missed something, though.
> > >
> > >
> > >
> > > - Scott
> >
> > Oppps...sorry. I had bookmarked a few studies with SRI/SRI combos, but now when I need them, I can't find them..urrgghh..lol. Yes, the study I referenced was a CBT/SRI study.
> >
> > But, my personal, subjective experience is only n=1, but I swear, I came across a few studies talking about both SRI/SRI and SNRI/SRI combos. One in particular, citalopram and venlafaxine, eased me right out of a horrid mixed episode.
> >
> > Sorry...
>
>
> You ought to be!
>
> <grin>
>
>
> I found that my supposition regarding the possibility of there being subtypes of the serotonin transporter (SERT) has a factual basis.
>
> "The human serotonin transporter gene (5-HTT) demonstrates two polymorphisms with possible functional impact: a 44-bp insertion/deletion polymorphism of the promoter region and a 17-bp variable number of tandem repeat polymorphism (VNTR) in intron 2 (STin2)."
>
> https://www.nature.com/articles/4000821
>
> I propose that two different serotonin transporters might need two different drugs (ligands) to block both of them robustly. Of course, one drug might be able to attach to both SERT subtypes equally.
>
> For you, Jay, the question is whether or not venlafaxine and citalopram are each selective for a different serotonin transporter subtype. If so, that would explain your superior response to a combination of both drugs.
>
>
> - Scott
>
>

Very interesting Scott! There is so, so much that we have yet to discover. To this day, even after almost 30 years as a psychonaught (lol), I am still 'fine tuning' my drug regiment. I retry old drugs that partially worked, in combo's with new drugs that partially work. I find that doing 'spurts' of drugs for 2-3 days, stopping for a few, then continuing (doing the start-stop always) seems to prevent the 'getting used of..' phenomenon. But, I have to admit, it is getting tiring as I get older. <sigh> :(

Jay

 

Re: Combining Prozac and Paxil.... Jay2112

Posted by SLS on April 9, 2022, at 20:16:54

In reply to Re: Combining Prozac and Paxil.... SLS, posted by Jay2112 on April 8, 2022, at 22:35:25

Hi, Jay.


> I found that my supposition regarding the possibility of there being subtypes of the serotonin transporter (SERT) has a factual basis.
>
> "The human serotonin transporter gene (5-HTT) demonstrates two polymorphisms with possible functional impact: a 44-bp insertion/deletion polymorphism of the promoter region and a 17-bp variable number of tandem repeat polymorphism (VNTR) in intron 2 (STin2)."
>
> https://www.nature.com/articles/4000821
>
> I propose that two different serotonin transporters might need two different drugs (ligands) to block both of them robustly. Of course, one drug might be able to attach to both SERT subtypes equally.
>
> For you, Jay, the question is whether or not venlafaxine and citalopram are each selective for a different serotonin transporter subtype. If so, that would explain your superior response to a combination of both drugs.

> Very interesting Scott! There is so, so much that we have yet to discover. To this day, even after almost 30 years as a psychonaught (lol), I am still 'fine tuning' my drug regiment. I retry old drugs that partially worked, in combo's with new drugs that partially work. I find that doing 'spurts' of drugs for 2-3 days, stopping for a few, then continuing (doing the start-stop always) seems to prevent the 'getting used of..' phenomenon.

As you have commented many times in the past, our patterns of reactions to drugs are very similar.

I managed to develop a destructive habit of changing drug dosages too quickly. With both Nardil and Parnate, I would get a short, but significant improvement when increasing OR decreasing the dosages. I was too easily fooled. So many drugs have "tickled" my brain into having a brief improvement that usually lasted for no more than 3 days.

> But, I have to admit, it is getting tiring as I get older. <sigh> :(

Truthfully, I don't know how any of us on this site have made it this far. Now that I am feeling better, I have a much greater appreciation for horrendous existence that we have all endured. It takes a heroic effort to wake up each morning and to look forward only to escaping into sleep again that night.

Your words leave me with the impression that, although you might be tired at the moment, you still have plenty of positive energy.

I wish I could tell you with certainty that you will achieve remission tomorrow. I can't, obviously. However, who among us can claim to be certain that you won't? Uncertainty is what has kept you alive this long. I don't see that changing with you any time soon.

The only thing I can do for you right now is pray.

Okay. Done.

I pray it helps.

:-)


- Scott


 

Re: Combining Prozac and Paxil.... SLS

Posted by Jay2112 on April 14, 2022, at 22:08:27

In reply to Re: Combining Prozac and Paxil.... Jay2112, posted by SLS on April 9, 2022, at 20:16:54

> Hi, Jay.
>

Hi Scott!

> > I found that my supposition regarding the possibility of there being subtypes of the serotonin transporter (SERT) has a factual basis.
> >
> > "The human serotonin transporter gene (5-HTT) demonstrates two polymorphisms with possible functional impact: a 44-bp insertion/deletion polymorphism of the promoter region and a 17-bp variable number of tandem repeat polymorphism (VNTR) in intron 2 (STin2)."
> >
> > https://www.nature.com/articles/4000821
> >
> > I propose that two different serotonin transporters might need two different drugs (ligands) to block both of them robustly. Of course, one drug might be able to attach to both SERT subtypes equally.
> >
> > For you, Jay, the question is whether or not venlafaxine and citalopram are each selective for a different serotonin transporter subtype. If so, that would explain your superior response to a combination of both drugs.
>
> > Very interesting Scott! There is so, so much that we have yet to discover. To this day, even after almost 30 years as a psychonaught (lol), I am still 'fine tuning' my drug regiment. I retry old drugs that partially worked, in combo's with new drugs that partially work. I find that doing 'spurts' of drugs for 2-3 days, stopping for a few, then continuing (doing the start-stop always) seems to prevent the 'getting used of..' phenomenon.
>
> As you have commented many times in the past, our patterns of reactions to drugs are very similar.
>
> I managed to develop a destructive habit of changing drug dosages too quickly. With both Nardil and Parnate, I would get a short, but significant improvement when increasing OR decreasing the dosages. I was too easily fooled. So many drugs have "tickled" my brain into having a brief improvement that usually lasted for no more than 3 days.
>


Yes, I remember when Effexor XR first came out, 1998, here in Canada, and the manic moon orbit trip I was on...oh boy, I wouldn't mind that again! lol.


> > But, I have to admit, it is getting tiring as I get older. <sigh> :(

> Truthfully, I don't know how any of us on this site have made it this far. Now that I am feeling better, I have a much greater appreciation for horrendous existence that we have all endured. It takes a heroic effort to wake up each morning and to look forward only to escaping into sleep again that night.
>
> Your words leave me with the impression that, although you might be tired at the moment, you still have plenty of positive energy.
>
> I wish I could tell you with certainty that you will achieve remission tomorrow. I can't, obviously. However, who among us can claim to be certain that you won't? Uncertainty is what has kept you alive this long. I don't see that changing with you any time soon.
>
> The only thing I can do for you right now is pray.
>
> Okay. Done.
>
> I pray it helps.

Scott, one of the key elements I learned in addictions and mental health as a counsellor, is that the idea of HOPE is fundamental to recovery, and is what we all need. Without it, we can't start the day. No matter age, sex, whatever....every single human being deserves hope..IMHO. Yes, even the 'bad guys'...with whom could very well turn into good guys, with a little hope. :) Every day....new developments....new hope. Your resilience is quite astonishing...absolutely!


> :-)
>
>
> - Scott
>
>
>
>
>

Keep on smiling...keep on shining. :)

Jay

 

Re: Combining Prozac and Paxil.... Jay2112

Posted by SLS on April 15, 2022, at 9:13:25

In reply to Re: Combining Prozac and Paxil.... SLS, posted by Jay2112 on April 14, 2022, at 22:08:27

Hi again, Jay.


> Hi Scott!
>
> > > I found that my supposition regarding the possibility of there being subtypes of the serotonin transporter (SERT) has a factual basis.
> > >
> > > "The human serotonin transporter gene (5-HTT) demonstrates two polymorphisms with possible functional impact: a 44-bp insertion/deletion polymorphism of the promoter region and a 17-bp variable number of tandem repeat polymorphism (VNTR) in intron 2 (STin2)."
> > >
> > > https://www.nature.com/articles/4000821
> > >
> > > I propose that two different serotonin transporters might need two different drugs (ligands) to block both of them robustly. Of course, one drug might be able to attach to both SERT subtypes equally.
> > >
> > > For you, Jay, the question is whether or not venlafaxine and citalopram are each selective for a different serotonin transporter subtype. If so, that would explain your superior response to a combination of both drugs.


> > > Very interesting Scott! There is so, so much that we have yet to discover. To this day, even after almost 30 years as a psychonaught (lol), I am still 'fine tuning' my drug regiment. I retry old drugs that partially worked, in combo's with new drugs that partially work. I find that doing 'spurts' of drugs for 2-3 days, stopping for a few, then continuing (doing the start-stop always) seems to prevent the 'getting used of..' phenomenon.

> > As you have commented many times in the past, our patterns of reactions to drugs are very similar.
> >
> > I managed to develop a destructive habit of changing drug dosages too quickly. With both Nardil and Parnate, I would get a short, but significant improvement when increasing OR decreasing the dosages. I was too easily fooled. So many drugs have "tickled" my brain into having a brief improvement that usually lasted for no more than 3 days.


> Yes, I remember when Effexor XR first came out, 1998, here in Canada, and the manic moon orbit trip I was on...oh boy, I wouldn't mind that again! lol.
>
>
> > > But, I have to admit, it is getting tiring as I get older. <sigh> :(


> > Truthfully, I don't know how any of us on this site have made it this far. Now that I am feeling better, I have a much greater appreciation for horrendous existence that we have all endured. It takes a heroic effort to wake up each morning and to look forward only to escaping into sleep again that night.
> >
> > Your words leave me with the impression that, although you might be tired at the moment, you still have plenty of positive energy.
> >
> > I wish I could tell you with certainty that you will achieve remission tomorrow. I can't, obviously. However, who among us can claim to be certain that you won't? Uncertainty is what has kept you alive this long. I don't see that changing with you any time soon.
> >
> > The only thing I can do for you right now is pray.
> >
> > Okay. Done.
> >
> > I pray it helps.


> Scott, one of the key elements I learned in addictions and mental health as a counsellor, is that the idea of HOPE is fundamental to recovery, and is what we all need. Without it, we can't start the day. No matter age, sex, whatever....every single human being deserves hope..IMHO. Yes, even the 'bad guys'...with whom could very well turn into good guys, with a little hope. :) Every day....new developments....new hope. Your resilience is quite astonishing...absolutely!

Just remember, *uncertainty* is your best friend. It is uncertainty that allows you to wake up each morning knowing that there is a possibility that you are one day closer to remission and a life of clarity, reward, and unfettered personal growth.


- Scott



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