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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by kreedi on February 7, 2002, at 1:11:54
I've been on and off Prozac (three or four times) since 1995. First time I took it for eight months or so; the next couple of times, only for a few months, discontinued after I felt better (largely because of the sexual side-effects). Haven't really tried any other drug -- though my psychopharmacologist in the States had me on, briefly, at different times, lithium, valproic acid, lamictal (the idea being, I guess, to prevent a manic episode, smooth out mood "irregularities"). Never more than a few weeks on any. I even tried Ritalin for a while. I guess I'm one of those people who has trouble sticking to any one thing, even medication.
I started taking Prozac again recently -- third week now, first week 10mg, 20mg after that. But I still feel terrible; losing weight also (which makes me feel worse). No motivation to do the things I need to do. Self-esteem low. Hopelessness, bleakness.
Not sure what to do. Sertraline (Zoloft) made me virtually impotent last year -- I took it for only ten days. Luckily, last January's (2001) episode lifted
pretty quickly.Around July last year, felt the awfulness of depression returning. Wellbutrin for a couple of weeks, 150 mg SR, but lots of weight loss, insomnia. Then Remeron -- at 7.5 mg it made be unbearably groggy for a full 24 hours. I knew that a higher dose might not cause oversedation, but I was too scared to try -- what if 30mg meant I wouldn't wake up for three days?
Now, I've been feeling depressed again for the last couple of months. And Prozac doesn't seem to be working yet.
Also in long-term psychoanalysis -- over three years now. It helps me gain a lot of insight, and I've ceased a lot of self-destructine behavior because of it, but doesn't help through a depressive episode. I sometimes wonder, in fact, if the analysis is indirectly contributing to the greater frequency of depressive episodes, by making me confront a lot of my own crazy assumptions about life.
My questions are: (1) Should I stick with the Prozac? Lower the dose to 10mg (lowering the dose seems to help some people, right?) or increase to 30mg?
(2) Should I/Can I combine Wellbutrin and Remeron? Do they work well together for depression? And, as for the side-effects, will the weight-loss and insomnia that bupropion causes "cancel out" the sedation and weight gain that mirtazapine causes?
(3) Try the tricyclics or even MAOIs? Mood stabilizers? (Some of the newer drugs aren't available where I live yet.)
(4) ANY feedback welcome.
Thanks, K.
Posted by kreedi on February 7, 2002, at 1:16:03
In reply to prozac/general meds query, posted by kreedi on February 7, 2002, at 1:11:54
Forgot to mention that I also take alprazolam (Xanax) whenever I need to (maybe couple of times a week) to deal with anxiety.
Posted by TSA West on February 7, 2002, at 9:58:15
In reply to prozac/general meds query, posted by kreedi on February 7, 2002, at 1:11:54
Hello from the Western US, Kreedi...
The Prozac is the only medication that you seem to reach a therapeutic dose of (20 mg), whereas the others you did not (150 mg of Wellbutrin; 7.5 mg of Remeron; and the others you did not specify {Zoloft}). You could wait another few weeks for the Prozac to materialize or you could try something substantially different like venlafaxine (easily tolerated and respected) or the simple tricyclic desipramine (the easiest-to- tolerate tricyclic). As far as adding meds to one another now: Its always a good idea to not combine medications yet until you know what does what.
Last thought: Remeron is a superior and novel medicine. I wish you could pursue that one further.
Kindly,
TSA West---------------------------- :)
Posted by Elizabeth on February 7, 2002, at 21:47:02
In reply to prozac/general meds query, posted by kreedi on February 7, 2002, at 1:11:54
Hi there.
I think you should definitely try going higher on the Remeron. My pdoc says he always starts people at 30 mg and he's found that they tolerate that better. You know your fear is irrational, right? :-) Seriously: do you ever talk to your analyst about the way that you jump from one med to the next? I think that could be very destabilizing, and it might be contributing to your problems.
BTW, I think that while psychoanalysis might leave you upset after a session, in the long term it's more likely to help you feel more stable and at ease than to worsen your depression. I'm assuming that you have an analyst you're comfortable with, since you've been doing it for three years.
> My questions are: (1) Should I stick with the Prozac? Lower the dose to 10mg (lowering the dose seems to help some people, right?) or increase to 30mg?
If the side effects are causing problems at just 20 mg, maybe you should try going down to 10. That's my opinion. A lot of people need to start taking SSRIs at low doses.
> (2) Should I/Can I combine Wellbutrin and Remeron?
I think Remeron might be good to add. It can help alleviate some of the side effects of SSRIs, such as anxiety, insomnia, weight gain, sexual dysfunction, etc. You could also combine WB and Remeron. But TSA West's advice -- don't mix things until you've figured out what the first thing does -- is good, and you should definitely heed it.
> (3) Try the tricyclics or even MAOIs? Mood stabilizers? (Some of the newer drugs aren't available where I live yet.)
It depends what sort of depression you have. "Depression" covers a lot of territory, and I'm not sure what you're dealing with.
You should probably try the newer ADs first, since they're generally safer. (MAOIs and TCAs aren't anything to be afraid of, but they're no longer first choices, that's all. It's pretty easy to manage the side effects of the TCAs and follow the dietary restrictions of the MAOIs.)
Welcome to Psycho-Babble. :-)
-elizabeth
Posted by kreedi on February 8, 2002, at 1:11:12
In reply to Re: prozac/general meds query » kreedi, posted by TSA West on February 7, 2002, at 9:58:15
Thanks TSA West and Elizabeth, both your posts were very helpful! Kreedi
Posted by Ritch on February 8, 2002, at 10:09:20
In reply to prozac/general meds query, posted by kreedi on February 7, 2002, at 1:11:54
> I've been on and off Prozac (three or four times) since 1995. First time I took it for eight months or so; the next couple of times, only for a few months, discontinued after I felt better (largely because of the sexual side-effects). Haven't really tried any other drug -- though my psychopharmacologist in the States had me on, briefly, at different times, lithium, valproic acid, lamictal (the idea being, I guess, to prevent a manic episode, smooth out mood "irregularities"). Never more than a few weeks on any. I even tried Ritalin for a while. I guess I'm one of those people who has trouble sticking to any one thing, even medication.
>
> I started taking Prozac again recently -- third week now, first week 10mg, 20mg after that. But I still feel terrible; losing weight also (which makes me feel worse). No motivation to do the things I need to do. Self-esteem low. Hopelessness, bleakness.
>
> Not sure what to do. Sertraline (Zoloft) made me virtually impotent last year -- I took it for only ten days. Luckily, last January's (2001) episode lifted
> pretty quickly.
>
> Around July last year, felt the awfulness of depression returning. Wellbutrin for a couple of weeks, 150 mg SR, but lots of weight loss, insomnia. Then Remeron -- at 7.5 mg it made be unbearably groggy for a full 24 hours. I knew that a higher dose might not cause oversedation, but I was too scared to try -- what if 30mg meant I wouldn't wake up for three days?
>
> Now, I've been feeling depressed again for the last couple of months. And Prozac doesn't seem to be working yet.
>
> Also in long-term psychoanalysis -- over three years now. It helps me gain a lot of insight, and I've ceased a lot of self-destructine behavior because of it, but doesn't help through a depressive episode. I sometimes wonder, in fact, if the analysis is indirectly contributing to the greater frequency of depressive episodes, by making me confront a lot of my own crazy assumptions about life.
>
> My questions are: (1) Should I stick with the Prozac? Lower the dose to 10mg (lowering the dose seems to help some people, right?) or increase to 30mg?
>
> (2) Should I/Can I combine Wellbutrin and Remeron? Do they work well together for depression? And, as for the side-effects, will the weight-loss and insomnia that bupropion causes "cancel out" the sedation and weight gain that mirtazapine causes?
>
> (3) Try the tricyclics or even MAOIs? Mood stabilizers? (Some of the newer drugs aren't available where I live yet.)
>
> (4) ANY feedback welcome.
>
> Thanks, K.
Kreedi,I need to combine low-dose SSRI with either a TCA, Wellbutrin, or a pstim to get a proper antidepressant response. You might try dropping the Prozac down to 10mg (reduce the SSRI tiredness) and adding on some nortiptyline or desipramine (TCA), Wellbutrin, or a low-dose pstim. If you add on a TCA (esp.), you will have to wait out 2 full weeks before much of anything will happen, though.
Mitch
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