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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by blueberry on June 10, 2006, at 9:09:45
This happened three times in a row, first with prozac, then with lexapro, then with cymbalta...the first day or two I get a decent bounce and I think I'm on the right track. But between day 2 and day 4 I become much worse and start crying with no reason and no control, much more depressed than I had been to start with.
All doses had been very low since I seem very sensitive for some reason. That did not used to be the case in previous years. I have never had trouble starting an antidepressant before. Lexapro was 2.5mg, prozac was 2.5mg, cymbalta was 5mg.
I'm wondering...am I having a super difficult time getting through the initial down-regulation stage? Or does this reaction mean I am bipolar? Were the doses too low and I should have just braved normal doses right from the start? Your thoughts?
If the consensus is that it is a down-regulation stage, then I may have to go to the hospital or a partial day-hospital program to get through it. If the consensus is bipolar, then I need to look at mood stabilizers without antidepressants.
I ask all of you here because both of my doctors don't know what's going on. They keep saying, "that's odd, I've never seen that happen before". Or one doctor said suicidal ideation comes from too much serotonin squashing out norepinephrine and that cymbalta won't cause worsening of depression...but it did.
Posted by bassman on June 10, 2006, at 10:07:59
In reply to What does this mean when this happens...., posted by blueberry on June 10, 2006, at 9:09:45
Not only do I have EXACTLY the same thing happen, it also happens when I up the dose; I also start with very low doses. I'm in my third day of worse depression from going from 15 to 20 mg of Prozac. Usually then after a few days (I sure hope this time, too) the depression goes away and then gradually I get better, if I'm lucky. When I started Lexapro, I started at 10 mg and the same thing happened. I started Paxil at 1-2 mg, same boost-then depression thing.
I think it is fascinating to try to correlate the reaction to AD's to what might actually work-or if you will, what is actually wrong. But I might suggest not worrying about exactly what is happening with neurotransmitters, etc., since one day we might find out the "neurotransmitter hypothesis" may turn out to be wrong. The real question is, "what do we need to do to feel better?".An old pdoc friend of mine used to say that you might as well kiss off the two days after starting an AD to sleep. I wonder if this is related-just a bit more extreme.
Best luck, blueberry.
Posted by heaven help me on June 10, 2006, at 10:51:51
In reply to What does this mean when this happens...., posted by blueberry on June 10, 2006, at 9:09:45
Hey Blueberry,
I had lots of trouble with only ADs too. Finally, trying a mood stabilizer and an AP is what worked for me. (there is a slight waiting stage though while things get into place). I aksed my PA this: Which is worse, to take APs when you are Bipolar and have them make things worse, or to try an MS and an AP when you are not bipolar? He said that the risk in trying APs and MSs ws smaller than the pain of being on ADs, when you are actually BP. Does that make sense? Either way you are "trying something out" but it seems the risk was lower to try the MS and Aps. So, maybe they are worth a try. Whew, did ANYONE understnad that?
blessins
mary
Posted by SLS on June 10, 2006, at 11:00:59
In reply to What does this mean when this happens...., posted by blueberry on June 10, 2006, at 9:09:45
> This happened three times in a row, first with prozac, then with lexapro, then with cymbalta...the first day or two I get a decent bounce and I think I'm on the right track. But between day 2 and day 4 I become much worse and start crying with no reason and no control, much more depressed than I had been to start with.
What do you feel when you get more depressed?
I think your idea regarding downregulation has merit. When I was a patient at the NIH, the doctors there claimed that having an initial blip improvement was a good prognosticator of eventual response. Perhaps you could use pindolol, a 5-HT1a antagonist, as a buffer and accelerate your response. There was quite a bit of interest in using pindolol to augment antidepressants a few years back.
Have you ever managed to get to a therapeutic dosage of any SRI?
Buspar?
I'm sure you noticed that the three drugs you tried are all potent serotonin reuptake inhibitors. Perhaps you ought to look at drugs that don't do that. Something like desipramine or Remeron perhaps?
- Scott>
> All doses had been very low since I seem very sensitive for some reason. That did not used to be the case in previous years. I have never had trouble starting an antidepressant before. Lexapro was 2.5mg, prozac was 2.5mg, cymbalta was 5mg.
>
> I'm wondering...am I having a super difficult time getting through the initial down-regulation stage? Or does this reaction mean I am bipolar? Were the doses too low and I should have just braved normal doses right from the start? Your thoughts?
>
> If the consensus is that it is a down-regulation stage, then I may have to go to the hospital or a partial day-hospital program to get through it. If the consensus is bipolar, then I need to look at mood stabilizers without antidepressants.
>
> I ask all of you here because both of my doctors don't know what's going on. They keep saying, "that's odd, I've never seen that happen before". Or one doctor said suicidal ideation comes from too much serotonin squashing out norepinephrine and that cymbalta won't cause worsening of depression...but it did.
Posted by blueberry on June 10, 2006, at 12:32:25
In reply to Re: What does this mean when this happens.... » blueberry, posted by SLS on June 10, 2006, at 11:00:59
Hi Scott,
What do I feel when I get more depressed starting an AD? Well, basically depression just more intense...lots of uncontrollable crying, despair, hopelessness, worthlessness...feelings that were all there to begin with but somehow get magnified 10 fold.Your other question, yes I have been on therapeutic doses...20mg paxil, 20 prozac. I never had this kind of trouble getting there. I actually felt improvement fairly quickly and just had to bear the side effects as I waited for them to diminish over time. I never had worsened depression at the start. This is new.
Remeron 30mg...hated it. I was on it for a year with prozac. It didn't do much except help sleep a little bit but not enough.
Tried milnacipran for a few days...NE/5HT ratio of 3:1, and this same phenomenon happened. That's what makes me think it is a downregulation thing, or else a bipolar thing where any AD just sends me into a down cycle (though I never have up cycles).
This is all way too much for me and my family. I've had lots of experience with meds, but never the intensity and total incapacitation I have now. I honestly see no realistic option other than hospital to arrest this thing before more damage is done. If it is a downregulation thing, the hospital is the only place I can get through that, where I have encouragement, no job duties, no family concerns, just forget the world and get well. I know from experience that any AD can get me to a place where I am non-depressed, though extremely apathetic amotivational and not really into life, but getting there seems impossible. I would give anything to get back to that ssri numbness again. At least I know how to get rid of that (mentioned it to you in another post, hint hint).
> What do you feel when you get more depressed?
>
> I think your idea regarding downregulation has merit. When I was a patient at the NIH, the doctors there claimed that having an initial blip improvement was a good prognosticator of eventual response. Perhaps you could use pindolol, a 5-HT1a antagonist, as a buffer and accelerate your response. There was quite a bit of interest in using pindolol to augment antidepressants a few years back.
>
> Have you ever managed to get to a therapeutic dosage of any SRI?
>
> Buspar?
>
> I'm sure you noticed that the three drugs you tried are all potent serotonin reuptake inhibitors. Perhaps you ought to look at drugs that don't do that. Something like desipramine or Remeron perhaps?
>
>
> - Scott
>
> >
> > All doses had been very low since I seem very sensitive for some reason. That did not used to be the case in previous years. I have never had trouble starting an antidepressant before. Lexapro was 2.5mg, prozac was 2.5mg, cymbalta was 5mg.
> >
> > I'm wondering...am I having a super difficult time getting through the initial down-regulation stage? Or does this reaction mean I am bipolar? Were the doses too low and I should have just braved normal doses right from the start? Your thoughts?
> >
> > If the consensus is that it is a down-regulation stage, then I may have to go to the hospital or a partial day-hospital program to get through it. If the consensus is bipolar, then I need to look at mood stabilizers without antidepressants.
> >
> > I ask all of you here because both of my doctors don't know what's going on. They keep saying, "that's odd, I've never seen that happen before". Or one doctor said suicidal ideation comes from too much serotonin squashing out norepinephrine and that cymbalta won't cause worsening of depression...but it did.
>
>
Posted by rjlockhart on June 10, 2006, at 12:51:03
In reply to Re: What does this mean when this happens...., posted by heaven help me on June 10, 2006, at 10:51:51
I have gone to a partial hosptial program before when I thought i was going absolutely insane. Its depressing to go there. PHP i think that was you call it. Then i was steped down to intensive care hospitalization.
Bad Bad memories, i hated mental hospitals. Everyone smoked.... talked about midlife crisis, very deresssing, and im only 19! these people where in there 40's they could be my parents.
Listen, antidepressants are really hard to find out which one is the right one, i have been on lets see when i was 16 i started Zoloft, didnt work, then Wellbutrin 450mg it had me so anxious i was put on klonopin, then i was on Cymbalta 30mg nightly, Symbyax, then Prozac 20mg which i am currently on right now.
Prozac, effexor, are ok antidepressants, Cymbalta caused some sleep problems.
I am really sorry that you have crying spells. I had those, well i had freaking emotional outbursts, god , i rermber those days when i was on prescription dexedrine (amphetamines) whoooo man i went crazy. That one of the reasons i had to go the hospital.
Well i hope this is some kind of advice to you, i hope you get better.'
Ill be posting
Matt
Posted by Phillipa on June 10, 2006, at 21:41:06
In reply to Re: What does this mean when this happens...., posted by rjlockhart on June 10, 2006, at 12:51:03
Where have you been Matt. A lot of people have been worried about you. Love Phillipa
Posted by fairywings on June 12, 2006, at 15:32:58
In reply to What does this mean when this happens...., posted by blueberry on June 10, 2006, at 9:09:45
Hi blueberry, I'm really med sensitive too, and have to start everything at reallly low doses and move up slowly. Sometimes when I just barely pass the therapeutic window it sends me into a tailspin. I've had nothing but bad reactions to SSRI's even at a low dose. (Not that I think they're bad, just bad for me.) Are you and your pdoc willing to try just a mood stabilizer w/o an AD?
fw
Posted by bassman on June 12, 2006, at 17:51:12
In reply to What does this mean when this happens...., posted by blueberry on June 10, 2006, at 9:09:45
Oh, man, am I ever right there right now-I went from 15 to 20 mg of Prozac three days ago and I'm outright just-can-drag-myself-around depressed. And very anxious on top of that. Oh, and very sleepy. :>} $#@!
Posted by nicky847 on June 13, 2006, at 16:54:31
In reply to What does this mean when this happens...., posted by blueberry on June 10, 2006, at 9:09:45
In my experience, the first 4-5 weeks on SSRIs are a rollercoaster..and very difficult...if you don't bail on them though things start to even out and you do feel BETTER then you did before you started taking them..even if for a little while you feel worse when you start
This is the end of the thread.
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