![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by Phillipa on June 19, 2009, at 12:44:01
In reply to Sigh. Abilify is now prescribed. What about Luvox?, posted by Amelia_in_StPaul on June 19, 2009, at 12:22:28
Luvox certainly is no miracle med for me but the only one zero side effects with benzos. It was ativan when first on it. Is St Johns Wort A possibility? heard used a lot in Europe? Love Phillipa and it's Friday so better make a call.
Posted by manic666 on June 19, 2009, at 12:52:25
In reply to Sigh. Abilify is now prescribed. What about Luvox?, posted by Amelia_in_StPaul on June 19, 2009, at 12:22:28
i tried cymbalta an 50mg was as crap for me as 100 i take sertraline now 150mg its sort of like luvox ,i think there are 4 about the same prozac an whatever, i tried sertraline because its a ssri like prozac an that worked for me many years ago, its a bit hit an miss i take 150 mg now an all the zombie feel has gone, not right yet may have to go higher, i still take 4 loz a day, phillipa is on luvox
Posted by ricker on June 19, 2009, at 14:07:39
In reply to Sigh. Abilify is now prescribed. What about Luvox?, posted by Amelia_in_StPaul on June 19, 2009, at 12:22:28
Hi Amelia, hang in there!!! I did not do good on cybalta and 2 months on luvox was like walking around with chronic fatigue.I've never felt so tired, had to take naps during the day, zero motivation.... my luvox experience!
Zoloft has worked best for me but it took 2 attempts and approx. 2 months to get over the mild irritability, then clear sailing.
Wish I could be of more help, trial and error is tough, but I'm sure you'll find the right combo. :)
Take care, Rick
Posted by floatingbridge on June 19, 2009, at 18:13:13
In reply to Sigh. Abilify is now prescribed. What about Luvox?, posted by Amelia_in_StPaul on June 19, 2009, at 12:22:28
Interesting. I did 2 mg Abilify for about ten months--no weight gain. I felt fine, very transparent, until my dose was upped to 10mg. (O.K. so maybe that feeling 'fine' was relative; ) ) It was an add-on for a cycle of ADs.
Wow, if you could go the route of supplements, more power to you!
IMHO, if you're not 100% or even 90% about your script, call your doc and discuss it further.
And what about this new Savella?
Posted by Amelia_in_StPaul on June 19, 2009, at 19:31:40
In reply to Re: Sigh. Abilify is now prescribed. What about Lu, posted by floatingbridge on June 19, 2009, at 18:13:13
Hi Candace, I just got back from doc's. She said that if I wasn't comfortable trying Abilify yet I could try the Luvox. Whew! Do you think Savella will be good as an AD? I keep reading about it in terms of fibro. I would love to go the route of supplements, but I think it's not going to happen right now after all. I've been feeling in the dumps and have only been off Prozac for a couple of weeks, tops, maybe more like 10 days. :-( I can always dream of some day, right? :-)
> Interesting. I did 2 mg Abilify for about ten months--no weight gain. I felt fine, very transparent, until my dose was upped to 10mg. (O.K. so maybe that feeling 'fine' was relative; ) ) It was an add-on for a cycle of ADs.
>
> Wow, if you could go the route of supplements, more power to you!
>
> IMHO, if you're not 100% or even 90% about your script, call your doc and discuss it further.
>
> And what about this new Savella?
>
>
Posted by Amelia_in_StPaul on June 19, 2009, at 19:34:07
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox? » Amelia_in_StPaul, posted by ricker on June 19, 2009, at 14:07:39
Thanks very much for the encouragement! I already have CFS/fibro so I know I don't need more of that. ;-)
> Hi Amelia, hang in there!!! I did not do good on cybalta and 2 months on luvox was like walking around with chronic fatigue.
>
> I've never felt so tired, had to take naps during the day, zero motivation.... my luvox experience!
>
> Zoloft has worked best for me but it took 2 attempts and approx. 2 months to get over the mild irritability, then clear sailing.
>
> Wish I could be of more help, trial and error is tough, but I'm sure you'll find the right combo. :)
>
> Take care, Rick
>
>
Posted by Amelia_in_StPaul on June 19, 2009, at 19:35:46
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox?, posted by manic666 on June 19, 2009, at 12:52:25
hi manic, thanks for the message! I hope the serataline (sp?) does well for you in the end. I take the loraz too.
> i tried cymbalta an 50mg was as crap for me as 100 i take sertraline now 150mg its sort of like luvox ,i think there are 4 about the same prozac an whatever, i tried sertraline because its a ssri like prozac an that worked for me many years ago, its a bit hit an miss i take 150 mg now an all the zombie feel has gone, not right yet may have to go higher, i still take 4 loz a day, phillipa is on luvox
Posted by Amelia_in_StPaul on June 19, 2009, at 19:37:56
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox? » Amelia_in_StPaul, posted by Phillipa on June 19, 2009, at 12:44:01
Phillipa do you take the short-acting Luvox or the new CR? I did get in to see my pdoc today and she said that she would prescribe it instead of abilify as long as the short-acting is still manufactured (she said she doesn't like to start someone on the long acting of anything right away). thanks much phillipa!
> Luvox certainly is no miracle med for me but the only one zero side effects with benzos. It was ativan when first on it. Is St Johns Wort A possibility? heard used a lot in Europe? Love Phillipa and it's Friday so better make a call.
Posted by Phillipa on June 19, 2009, at 20:31:27
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox? » Phillipa, posted by Amelia_in_StPaul on June 19, 2009, at 19:37:56
Short acting won't take anything time realeased. Love Phillipa
Posted by jerrypharmstudent on June 20, 2009, at 20:36:12
In reply to Sigh. Abilify is now prescribed. What about Luvox?, posted by Amelia_in_StPaul on June 19, 2009, at 12:22:28
> Okay, here's what's happening. Any feedback is appreciated...
>
> Pristiq was an unqualified disaster. My pdoc, looking at the long list of SSRIs and SNRIs I tried, and failed or couldn't tolerate, has prescribed 1 mg Abilify as a standalone (still keeping my ativan for anxiety and trazodone for sleep).
>
> There are, however, two SRIs I have not tried: Cymbalta (I don t expect that I could tolerate it, though) and Luvox. I have heard of great success with Luvox.
>
> After all my trouble with meds, I am very, very resistant to jumping to another class. I have read that people on Abilify can gain weight over time. I already have 15 lbs to lose, which has really affected my self esteem.
>
> Couldn't I just--has anyone--be okay on supplements? Should I ring my pdoc and ask about Luvox?
>
> Tired and mired (but better than wired and tired), Amelia
WHen I was on Abilify I lost weight. No weight gain issues or increased appetite for me.
Posted by morganpmiller on June 20, 2009, at 22:24:49
In reply to Re: Sigh. Abilify is now prescribed. What about Lu » Amelia_in_StPaul, posted by jerrypharmstudent on June 20, 2009, at 20:36:12
I would stay away from Abilify if you can. I hate that they are mega marketing this drug as an antidepressant. There are cleaner safer drugs for millions out there that do NOT need Abilify. I'm not at all opposed to the use of Abilify for many, I just think it is being marketed and hyped and this is influencing P Docs everywhere to prescribe it. I can't stand that commercial where they talk about your antidepressant alone not being enough. Um, Yeah! antidepressants alone are never enough! I was on Zoloft for 8 years. I was depressed and had bouts of anxiety so many times during those 8 years. I easily could have perceived some of my depressive periods on Zoloft as "Poop Out". I don't believe Zoloft was pooping out on me as much as I was pooping out on me. I always stuck with zoloft, never changed the dosage, and just kept working out, going to therapy, hanging with friends, staying away from too much alcohol(even when i drank too much I didn't have as many issues as you would think). I just get the feeling that people are not taking care of themselves in so many ways other than just taking a medication. One of the reasons why I am not still doing well and taking Zoloft is because I made a HUGE mistake and got off of it thinking I would never need medication again. My story is complicated, there are other things that have happened since I got off Zoloft.
Anyway, say no to over marketed drugs like abilify unless you have exhausted all options or have a condition that simply cannot be treated with other safer alternatives.
Also, after being on and off so many different medications, it is possible that you may not respond as well as you normally would to a new medication. That's why I try to encourage anyone who is experiencing what they perceive to be a "poop out" to try to stick it out and pay attention to what other things are going on in their life that may be causing the depression/anxiety. I'm not saying medications don't "poop-out", I'm just saying that it may not happen as often as people think it does.
Posted by emme on June 21, 2009, at 6:03:46
In reply to Sigh. Abilify is now prescribed. What about Luvox?, posted by Amelia_in_StPaul on June 19, 2009, at 12:22:28
> Okay, here's what's happening. Any feedback is appreciated...
>
> Pristiq was an unqualified disaster. My pdoc, looking at the long list of SSRIs and SNRIs I tried, and failed or couldn't tolerate, has prescribed 1 mg Abilify as a standalone (still keeping my ativan for anxiety and trazodone for sleep).
>
> There are, however, two SRIs I have not tried: Cymbalta (I don t expect that I could tolerate it, though) and Luvox. I have heard of great success with Luvox.
>
> After all my trouble with meds, I am very, very resistant to jumping to another class. I have read that people on Abilify can gain weight over time. I already have 15 lbs to lose, which has really affected my self esteem.
>
> Couldn't I just--has anyone--be okay on supplements? Should I ring my pdoc and ask about Luvox?
>
> Tired and mired (but better than wired and tired), AmeliaIf weight gain is your only worry about Abilify, I wouldn't discount it too quickly. Yes, there can be a slow, sneaky weight gain on it, and that is something to watch out for. But I have the impression that is not universal.
Abilify has been a far more reliable antidepressant for me than those classified as antidepressants. I have stopped caring about the class of a drug as long as it works well and the side effects are tolerable.
I know supplements are tempting and that there are people who find them very helpful. But remember that you are still introducing a substance into your body and there may be problems. 5HTP rapidly made me a complete and total wreck. Melatonin made me more depressed. St. John's Wort (Kira brand) did nothing but make me logy and queasy. SAM-e was a bust. Alternative remedies are worth looking into, but don't be surprised if it's hit or miss like prescription drugs. Fish oil should be pretty benign and there have been controlled studies on it - I'd probably start there. Check out the "alternative" board.
Good luck.
emme
Posted by Brainbeard on June 21, 2009, at 7:14:44
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox? » Amelia_in_StPaul, posted by emme on June 21, 2009, at 6:03:46
I've been on Luvox for only half a year. In my case, it worked well for depression, didn't do much for anxiety, and made me very apathetic.
The drug did have a clean feeling about it, though. And it combined perfectly with benzo's, though that may not be much of a recommendation. I tried to watch 'The Ring' while on Luvox and Ativan. Still was too scary for me, though.
Any SSRI will make you gain weight in the long run. Paxil (paroxetine) and Celexa (citalopram) are among the worst offenders.
Prozac is the dirtiest (chemically speaking) of the SSRIs, and works on noradrenaline and dopamine too. It can be taken in baby doses (<5mg) as an antidepressant stimulant. Even on such small doses it made me gain weight though.As a general rule, any antidepressant that works well will make you gain weight. There are few exceptions (bupropion/Wellbutrin being one).
Posted by Phillipa on June 21, 2009, at 19:23:53
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox?, posted by Brainbeard on June 21, 2009, at 7:14:44
Been on luvox for many years with benzos at first high dose 250mg and then seemed my body didn't tolerate them but then this was the same time lyme's was discovered in me no idea if related but since that time luvox at 50mg is my dose and doesn't really work. No weight gain though???? Phillipa
Posted by Amelia_in_StPaul on June 22, 2009, at 11:04:16
In reply to Re: Sigh. Abilify is now prescribed. What about Lu, posted by morganpmiller on June 20, 2009, at 22:24:49
My feeling is to stay away from it.
Yes, I have experienced poop out. Yes, meds alone aren't enough. Someone who has worked as hard as I have to get better, and then find themselves back at square one--yeah, that's poop out.
> I would stay away from Abilify if you can. I hate that they are mega marketing this drug as an antidepressant. There are cleaner safer drugs for millions out there that do NOT need Abilify. I'm not at all opposed to the use of Abilify for many, I just think it is being marketed and hyped and this is influencing P Docs everywhere to prescribe it. I can't stand that commercial where they talk about your antidepressant alone not being enough. Um, Yeah! antidepressants alone are never enough! I was on Zoloft for 8 years. I was depressed and had bouts of anxiety so many times during those 8 years. I easily could have perceived some of my depressive periods on Zoloft as "Poop Out". I don't believe Zoloft was pooping out on me as much as I was pooping out on me. I always stuck with zoloft, never changed the dosage, and just kept working out, going to therapy, hanging with friends, staying away from too much alcohol(even when i drank too much I didn't have as many issues as you would think). I just get the feeling that people are not taking care of themselves in so many ways other than just taking a medication. One of the reasons why I am not still doing well and taking Zoloft is because I made a HUGE mistake and got off of it thinking I would never need medication again. My story is complicated, there are other things that have happened since I got off Zoloft.
>
> Anyway, say no to over marketed drugs like abilify unless you have exhausted all options or have a condition that simply cannot be treated with other safer alternatives.
>
> Also, after being on and off so many different medications, it is possible that you may not respond as well as you normally would to a new medication. That's why I try to encourage anyone who is experiencing what they perceive to be a "poop out" to try to stick it out and pay attention to what other things are going on in their life that may be causing the depression/anxiety. I'm not saying medications don't "poop-out", I'm just saying that it may not happen as often as people think it does.
>
>
>
>
>
Posted by Amelia_in_StPaul on June 22, 2009, at 11:29:10
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox? » Amelia_in_StPaul, posted by emme on June 21, 2009, at 6:03:46
Weight gain isn't the only concern, although I probably presented it that way. Classes of drugs matter to me. One, because I have a genetic mutation that means I don't metabolize drugs well that use P450 2D6. That includes SSRIs, SNRIs (which I have allergic reactions to anyway), APs. So I am thinking I don't even want to try again any of the drugs that use 2D6, including Luvox and Abilify. Two, because I do not want to mess with dopamine, not to the level that APs do it.
When I first went on Prozac 17 years ago, I did not have major depression. Now, whenever I try to get off Prozac, I plummet. Yet, it doesn't work anyway, not well. It has pooped out, and after awhile, true to my 2D6 problem, the drug seems to saturate my system, and the side effects become overwhelming.
I do not want a similar thing to happen after taking antipsychotics. Plus, APs aren't safe drugs, IMO, either. With the risk of tardive dyskenesia and other extra-pyramidal symptoms--of which I would be more likely to get because of my 2D6 problem--I've read the studies--I am not interested.
People who take abilify and love it--I am glad for them. They are probably normal metabolizers, with two perfect alleles for the 2D6 enzyme. Seems like heaven to me. Sigh.
> > Okay, here's what's happening. Any feedback is appreciated...
> >
> > Pristiq was an unqualified disaster. My pdoc, looking at the long list of SSRIs and SNRIs I tried, and failed or couldn't tolerate, has prescribed 1 mg Abilify as a standalone (still keeping my ativan for anxiety and trazodone for sleep).
> >
> > There are, however, two SRIs I have not tried: Cymbalta (I don t expect that I could tolerate it, though) and Luvox. I have heard of great success with Luvox.
> >
> > After all my trouble with meds, I am very, very resistant to jumping to another class. I have read that people on Abilify can gain weight over time. I already have 15 lbs to lose, which has really affected my self esteem.
> >
> > Couldn't I just--has anyone--be okay on supplements? Should I ring my pdoc and ask about Luvox?
> >
> > Tired and mired (but better than wired and tired), Amelia
>
> If weight gain is your only worry about Abilify, I wouldn't discount it too quickly. Yes, there can be a slow, sneaky weight gain on it, and that is something to watch out for. But I have the impression that is not universal.
>
> Abilify has been a far more reliable antidepressant for me than those classified as antidepressants. I have stopped caring about the class of a drug as long as it works well and the side effects are tolerable.
>
> I know supplements are tempting and that there are people who find them very helpful. But remember that you are still introducing a substance into your body and there may be problems. 5HTP rapidly made me a complete and total wreck. Melatonin made me more depressed. St. John's Wort (Kira brand) did nothing but make me logy and queasy. SAM-e was a bust. Alternative remedies are worth looking into, but don't be surprised if it's hit or miss like prescription drugs. Fish oil should be pretty benign and there have been controlled studies on it - I'd probably start there. Check out the "alternative" board.
>
> Good luck.
> emme
>
Posted by Amelia_in_StPaul on June 22, 2009, at 11:30:56
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox?, posted by Brainbeard on June 21, 2009, at 7:14:44
Yeah, I've been on wellbutrin. That was great, until it caused panic attacks. So what are you on now? I dislike feeling dead on medication. Yet, that's where it went with me with SSRIs.
I like your name.
Posted by Brainbeard on June 22, 2009, at 12:53:17
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox? » Brainbeard, posted by Amelia_in_StPaul on June 22, 2009, at 11:30:56
> Yeah, I've been on wellbutrin. That was great, until it caused panic attacks. So what are you on now? I dislike feeling dead on medication. Yet, that's where it went with me with SSRIs.
>
> I like your name.Thanks. I like it too. To me it evokes the image of a legendary pirate who had his brains growing out of his chin.
I absolutely dislike feeling dead on medication too. The benefit of being dead emotionally is that you can't feel fear or depression. But it's a rather crude solution.
Right now I'm in an experimental phase med-wise. I tried sertraline (aka Zoloft) for a couple of weeks but quit prematurely. I've started low dose imipramine (aka Tofranil). So far I think it's a splendid drug. There's some amitriptyline (aka Elavil) on the way; I'd like to try and combine low dose imipramine with low dose amitriptyline for several reasons (it comes down to combining benefits). Then I also think about returning to sertraline, but low dose (25mg). And I'm trying low dose ondansetron, a drug normally used as an anti-emetic, i.e. anti-nausea drug, being a 5HT3-
antagonist, for anxiety. There have been some promising studies. Can't tell yet if it works. I've just discovered that ondansetron and other 5HT3-antagonists indirectly inhibit dopamine transmission. Which is in itself not cool. But it's another clue that anxiety disorders are related to the dopaminergic system, perhaps even more than to the serotonergic system. And the SSRIs might work for anxiety because eventually they screw up your dopaminergic circuits. That might even be the reason that for OCD, the SSRIs often start to work only after several months (instead of weeks as with depression).I'm suspecting that the TCA's are less likely to kill your emotions, although they can be rather sedating at first. Anyhow, I think I wanna stay away from total serotonin reuptake inhibition, because it obviously messes up your dopamine system, resulting in libido problems, emotional numbness, apathy, etcetera; in short: having less fun and being less alive. That's why I'm not taking clomipramine, the TCA that works excellent for OCD (which I have), but is such a strong SRI that it messes with your dopamine big time.
Posted by Amelia_in_StPaul on June 22, 2009, at 14:17:02
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox?, posted by Brainbeard on June 22, 2009, at 12:53:17
> Thanks. I like it too. To me it evokes the image of a legendary pirate who had his brains growing out of his chin.
That's exactly what I was thinking. But because of bluebeard, I was imagining a blue brain-beard. Ha! Love it.
> I absolutely dislike feeling dead on medication too. The benefit of being dead emotionally is that you can't feel fear or depression. But it's a rather crude solution.Exactly. And I'm a writer, who has wasted a lot of time falling into apathy for months on end. ARRGGH
> Right now I'm in an experimental phase med-wise. I tried sertraline (aka Zoloft) for a couple of weeks but quit prematurely. I've started low dose imipramine (aka Tofranil). So far I think it's a splendid drug.That's great. What flavor of depression did you/do you have (or are you mostly taking this for OCD)?
>There's some amitriptyline (aka Elavil) on the way; I'd like to try and combine low dose imipramine with low dose amitriptyline for several reasons (it comes down to combining benefits).
Sounds like you have a great doctor. This is the frustrating thing for me. I switched doctors b/c my original one was satisfied with how Prozac was working for me (um, suicidality is working for me?) and didn't ever want to hear my ideas; now this new doctor is doing some of the same things. She told me too much knowledge is not a good thing, psychiatry isn't my field, blah blah blah, then put me on a normal dose of pristiq even though I told her about my history w/meds and metabolism problem (2D6--have I mentioned that already? I'm sounding like a broken record). And now her solution is abilify. Grrreeaaat.
> Then I also think about returning to sertraline, but low dose (25mg). And I'm trying low dose ondansetron, a drug normally used as an anti-emetic, i.e. anti-nausea drug, being a 5HT3-
> antagonist, for anxiety. There have been some promising studies. Can't tell yet if it works. I've just discovered that ondansetron and other 5HT3-antagonists indirectly inhibit dopamine transmission. Which is in itself not cool. But it's another clue that anxiety disorders are related to the dopaminergic system, perhaps even more than to the serotonergic system.Do you mean too much dopamine? Interesting. I didn't know that.
> And the SSRIs might work for anxiety because eventually they screw up your dopaminergic circuits.
Amen. I know that to be true about Prozac.
> That might even be the reason that for OCD, the SSRIs often start to work only after several months (instead of weeks as with depression).
Also interesting.
>
> I'm suspecting that the TCA's are less likely to kill your emotions, although they can be rather sedating at first.I think they metabolize using 2D6 too. My problems with a couple of TCAs were similar to SSRIs.
> Anyhow, I think I wanna stay away from total serotonin reuptake inhibition, because it obviously messes up your dopamine system, resulting in libido problems, emotional numbness, apathy, etcetera; in short: having less fun and being less alive.
Totally agreed!!!
> That's why I'm not taking clomipramine, the TCA that works excellent for OCD (which I have), but is such a strong SRI that it messes with your dopamine big time.
Yes, I have OCD too. The pure O version (I know that's a misnomer; I do have mental compulsions, after all).
Well, tomorrow I see a psychiatrist not in contract with insurance companies. I figured out that I could mostly afford it, since I've met my out of pocket and deductibles (don't know if you've done that before; you submit your receipts to insurance, and, as long as you've met all your maximums, they pay it all, up to what they think a psychiatrist should charge--above that, you have to pay some--but I do have some $$ left in my spouse's health savings acct).
I'm hoping he is different. I am afraid maybe he will be a little too different though, lol, because he does prescribe acupuncture (which my insurance does not cover). I would LOVE to do acupuncture, but alas, I have no money for it.
Well, we'll see anyway. I just know I am not going back the SRI route. And I am NOT going on an antipsychotic. I am not wrecking my body any more.
Good luck to you. Sounds like you have a good idea of what's going on with you and what will work. You must have a heck of a good pdoc.
>
Posted by morganpmiller on June 23, 2009, at 0:24:10
In reply to Re: Sigh. Abilify is now prescribed. What about Lu » morganpmiller, posted by Amelia_in_StPaul on June 22, 2009, at 11:04:16
I hear ya..I'm sure poop out is real in many cases. No Abilify! If you can go without it. If not. abilify....
> My feeling is to stay away from it.
>
> Yes, I have experienced poop out. Yes, meds alone aren't enough. Someone who has worked as hard as I have to get better, and then find themselves back at square one--yeah, that's poop out.
>
>
>
> > I would stay away from Abilify if you can. I hate that they are mega marketing this drug as an antidepressant. There are cleaner safer drugs for millions out there that do NOT need Abilify. I'm not at all opposed to the use of Abilify for many, I just think it is being marketed and hyped and this is influencing P Docs everywhere to prescribe it. I can't stand that commercial where they talk about your antidepressant alone not being enough. Um, Yeah! antidepressants alone are never enough! I was on Zoloft for 8 years. I was depressed and had bouts of anxiety so many times during those 8 years. I easily could have perceived some of my depressive periods on Zoloft as "Poop Out". I don't believe Zoloft was pooping out on me as much as I was pooping out on me. I always stuck with zoloft, never changed the dosage, and just kept working out, going to therapy, hanging with friends, staying away from too much alcohol(even when i drank too much I didn't have as many issues as you would think). I just get the feeling that people are not taking care of themselves in so many ways other than just taking a medication. One of the reasons why I am not still doing well and taking Zoloft is because I made a HUGE mistake and got off of it thinking I would never need medication again. My story is complicated, there are other things that have happened since I got off Zoloft.
> >
> > Anyway, say no to over marketed drugs like abilify unless you have exhausted all options or have a condition that simply cannot be treated with other safer alternatives.
> >
> > Also, after being on and off so many different medications, it is possible that you may not respond as well as you normally would to a new medication. That's why I try to encourage anyone who is experiencing what they perceive to be a "poop out" to try to stick it out and pay attention to what other things are going on in their life that may be causing the depression/anxiety. I'm not saying medications don't "poop-out", I'm just saying that it may not happen as often as people think it does.
> >
> >
> >
> >
> >
>
>
Posted by emme on June 23, 2009, at 5:04:59
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox? » emme, posted by Amelia_in_StPaul on June 22, 2009, at 11:29:10
> One, because I have a genetic mutation that means I don't metabolize drugs well that use P450 2D6.
Just curious. How do you know this? Genetic testing? Also, when you say you don't metabolize those drugs well, does that mean a you have been advised by a doctor that you have a complete intolerance? Or might it mean that you would benefit by using hamster-sized doses?
Posted by Brainbeard on June 23, 2009, at 6:43:43
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox? » Brainbeard, posted by Amelia_in_StPaul on June 22, 2009, at 14:17:02
> Exactly. And I'm a writer, who has wasted a lot of time falling into apathy for months on end. ARRGGHI'm a singer-songwriter, mostly, and the problem is that my natural state has become one of serious creative inhibition. It used to be different when I was a regular marihuana user, but that would hardly be a solution in the phase of life I'm in right now..
> That's great. What flavor of depression did you/do you have (or are you mostly taking this for OCD)?
Well, clinically, it might not even be depression; perhaps it should be called 'dysthymia'. I guess 'melancholic depression' would apply more than 'endogenic depression'. In fact, my OCD and my depression are closely intertwined. I'm depressed because I'm convinced that I have been damaged or contaminated and that now life isn't worth living anymore.. That kind of viscuous circle.
> Sounds like you have a great doctor.Ha! Misunderstanding! I do have a great doctor, but guess who the doctor is? That's right, yours truly. My p-doc is just about to fire me because of my pharmacotherapeutical venturings. I think it annoys her sometimes that I know more about some pharmacological details than she does. She's told me that she can impossibly keep up with all the latest research; she just doesn't have the time. Still, she won't let me do the thinking. She'd rather prescribe me a med with serious and possibly dangerous side-effects that is according to protocol than prescribe me an experimental med that has virtually no side-effects but is off the well worn road.
> Do you mean too much dopamine? Interesting. I didn't know that.Not necessarily too much, but dopamine going wrong, at least; dopamine triggering anxiety. Dopamine and noradrenaline are closely connected to the fight-or-flight-response and thus to anxiety.
> I think they [TCA's, ed.] metabolize using 2D6 too. My problems with a couple of TCAs were similar to SSRIs.No no, not all of them. Clomipramine only uses 2D6 a little bit and is mostly metabolized by 1A2 and 3A4. Luvox (fluvoxamine) also doesn't even touch 2D6 but gets broken down by 1A2 and 3A4. Zoloft (sertraline) is metabolized mostly by 3A4; 2D6 plays only a minor role, perhaps it becomes more prominent on higher dosages, when sertraline also begins to inhibit 2D6. For imipramine too, 1A2 and 3A4 are more important than 2D6. Citalopram (Celexa) is not metabolized by 2D6 but by 2C19. Escitalopram (Lexapro) is mostly metabolized by 2C19 too, but also by 3A4 and 2D6.
So, from a 2D6 point of view, Luvox or Celexa would be completely fine.
> Yes, I have OCD too. The pure O version (I know that's a misnomer; I do have mental compulsions, after all).Pure O here too. I stopped performing classical (fysical) compulsions ages ago. Well, there are still some compulsive acts, but I don't wash my hands hundred times a day anymore, to mention something.
I'm buying most of my meds myself, over the internet. My p-doc was so friendly to prescribe the sertraline (Zoloft) for me. She didn't want to prescribe the ondansetron. I can only hope that I'll find a p-doc who writes prescriptions like there's no tomorrow.
>
Acupuncture - not for me. I stay clear from most alternative kinds of health care. Too much occultism. Wrong roots (just my opinion). In my country (Holland), most of that stuff is being covered though.> Well, we'll see anyway. I just know I am not going back the SRI route. And I am NOT going on an antipsychotic. I am not wrecking my body any more.
Hate to say it, but psychological problems can wreck your body (and your life, your relationship, etc.) too. Sometimes one has to choose the lesser evil.
> Good luck to you. Sounds like you have a good idea of what's going on with you and what will work. You must have a heck of a good pdoc.
I sure have. ;) No, thanks. And good luck to you.
Posted by Amelia_in_StPaul on June 23, 2009, at 11:55:00
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox? » Amelia_in_StPaul, posted by emme on June 23, 2009, at 5:04:59
Yes, I have had genetic testing, from Mayo. But actually, anyone could've guessed based on my response patterns to medicine. My pdoc at the time suspected the problem, sent me for the test, and explained the report--although with any amount of intellect, one can read the tests, read studies and research into these genetic mutations and polymorphisms, and figure this out.
Yes, in theory, being an IM (intermediate metabolizer) might mean that I would benefit from pea-sized doses, depending on the AD. If you are talking about a medicine like Prozac that BOTH inhibits 2D6 and is then metabolized by it, then no. A drug that inhibits an intermediate metabolizer renders that person a poor metabolizer = stay the h$ll away from the drug. Because essentially, Prozac is rendering ineffective the one allele I have that is correct, and yet is trying to get metabolized by that allele. I have allowed pdocs to put me back on it in the last year and a half because it is the one I have responded to, but true to the experience of an intermediate metabolizer, I eventually end up with overwhelming side effects. I suspected it before, after going off Prozac and feeling half-way normal, physically, but tested that out by going on for a period of 9 months and then off again, after becoming a zombie and feelign suicidal again. Yep, it was the Prozac.
Further, theoretically, an IM might be able to get by on smaller doses of a drug that, say, is metabolized by 2D6 but doesn't inhibit it--but it doesn't quite work that way in practice. I have been on smaller doses of meds, when I could get past the initial side effects, as I could with Prozac, and they don't work at a "sub-therapeutic" level. They don't quell my OCD, they don't dampen the depression. But when the medication is raised, it works for a bit and then the side effects become overwhelming.
"The intermediate metabolizers are a particularly tricky group, say some experts. They might feel positive results from a drug at first, but get sick over time as it slowly builds up in their bloodstream. But because they've been on the drug for weeks or months, they might not recognize their symptoms as an adverse reaction to it."
http://www.upstreambio.com/downloads/liver_success.pdfYeah. That's me. For 10 years I was sick on Prozac, and had no idea. 10 years. I get quite angry about it (though there's no one to get angry at--the pdocs didn't have the information, though I do think they could've listened to me better, trusted my intuition), because I have lost a lot of opportunities from sleeping 12 hours a night and feeling dead the whole day no matter how much sleep I was getting. A grant I won and then had to give back b/c I couldn't complete the work. A lucrative job I lost because the hour-long drive was killing me. Days I was too tired to write--days upon days upon days, until I am further behind than my peers. Not to mention how disorganized I was and am, how unfocused...all because I cannot take typical ADHD meds when I am already on an AD. Why? Because they are metabolized by 2D6 too. And when I take them with an AD, I get robobuzz--something kids actually try to achieve but which I find scary. It is essentially a saturation of the drugs--as though I had sniffed crushed stimulants--even though I had taken a small dose.
There are some drugs that aren't primarily metabolized by 2D6. Celexa, for instance. Which I tried. And it didn't work. Now I know why. Again rereading the report last night Apparently my polymorphisms = nonresponse to Celexa. Yay!
And what about Wellbutrin? Tried it by itself, without Prozac. I experienced a week of anxiety so bad I literally, literally, tried to climb the walls. So my pdoc told me to break it in half and try half a dose. Just as bad--actually worse, probably becuase you just aren't supposed to break up Wellbutrin. It spikes in your blood, that way. I don't know why the reaction to Wellbutrin, but Mayo is careful to say that not all polymorphisms and mutations are detected. There are other routes of metabolization that Mayo has not yet been able to test. I could be a poor metabolizer or intermediate metabolizer of those too.
All I know is I feel frustrated. My genetic profile is not making it easy for me to find and stay on drugs.
> > One, because I have a genetic mutation that means I don't metabolize drugs well that use P450 2D6.
>
> Just curious. How do you know this? Genetic testing? Also, when you say you don't metabolize those drugs well, does that mean a you have been advised by a doctor that you have a complete intolerance? Or might it mean that you would benefit by using hamster-sized doses?
>
>
>
Posted by Amelia_in_StPaul on June 23, 2009, at 12:13:45
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox?, posted by Brainbeard on June 23, 2009, at 6:43:43
> No no, not all of them. Clomipramine only uses 2D6 a little bit and is mostly metabolized by 1A2 and 3A4. Luvox (fluvoxamine) also doesn't even touch 2D6 but gets broken down by 1A2 and 3A4.
Hmmm...my Mayo report says that fluvoxamine is metabolized by 2D6. I have just done some googling--trusted sources say that it is metabolized by 2D6 but also by 1A2 and 3A4--perhaps the main thing is the multiple pathways, and the fact that it doesn't inhibit 2D6, unlike the other SSRIs. Inhibition is the key for me. It renders me a poor metabolizer.
> Zoloft (sertraline) is metabolized mostly by 3A4; 2D6 plays only a minor role, perhaps it becomes more prominent on higher dosages, when sertraline also begins to inhibit 2D6.Yes, I was just going to say, Zoloft does inhibit 2D6. So, I'm not interested in that. "There is variability among the drugs effective in the treatment of major depressive disorder in the extent of clinically important 2D6 inhibition, and in fact sertraline at lower doses has a less prominent inhibitory effect on 2D6 than some others in the class. Nevertheless, even sertraline has the potential for clinically important 2D6 inhibition." http://www.druglib.com/activeingredient/sertraline/
>
For imipramine too, 1A2 and 3A4 are more important than 2D6. Citalopram (Celexa) is not metabolized by 2D6 but by 2C19. Escitalopram (Lexapro) is mostly metabolized by 2C19 too, but also by 3A4 and 2D6.Celexa would be great. My genetic profile = nonresponse. I mean, I tried it and did not respond. Then I got this genetic testing; and my genetic profile shows that HTR2 polymorphisms would in fact lead a nonresponse to occur. So that's out.
Lexapro--I couldn't make it past the initial side effects. Very dirty drug, to me.
Imimpramine--yeah, I could try that.
> So, from a 2D6 point of view, Luvox or Celexa would be completely fine.
Yes. But, sigh, from my HTR2 profile, Celexa is out. I'll probably end up trying Luvox though.
> > Yes, I have OCD too. The pure O version (I know that's a misnomer; I do have mental compulsions, after all).
>
> Pure O here too. I stopped performing classical (fysical) compulsions ages ago. Well, there are still some compulsive acts, but I don't wash my hands hundred times a day anymore, to mention something.Wow, good for you!!!
> I'm buying most of my meds myself, over the internet. My p-doc was so friendly to prescribe the sertraline (Zoloft) for me. She didn't want to prescribe the ondansetron. I can only hope that I'll find a p-doc who writes prescriptions like there's no tomorrow.
That would be great. Let me know which rock that person is hiding under, so I can coax them out to help me too. :-)
> Acupuncture - not for me. I stay clear from most alternative kinds of health care. Too much occultism. Wrong roots (just my opinion). In my country (Holland), most of that stuff is being covered though.
Jeepers, you're kidding? It's covered? I wish. I have seen small studies that show an improvement. I personally think there is a scientific basis, not occultism. I think that the rush of endorphins that comes as a result of the needle-pricking is the key. But I am skeptical about lasting effects.
> > Well, we'll see anyway. I just know I am not going back the SRI route. And I am NOT going on an antipsychotic. I am not wrecking my body any more.
>
> Hate to say it, but psychological problems can wreck your body (and your life, your relationship, etc.) too. Sometimes one has to choose the lesser evilThank you. You're right. I was thinking about this last night. I get very angry at what I've gone through with Prozac, and with how little time pdocs have--and how little they actually listen to the patient. But I am quite sure that I won't get better without a medication. It's hard though when you haven't gotten better much at all over two years, and you have been on meds. I'm sure you understand my frustratin.
>
> > Good luck to you. Sounds like you have a good idea of what's going on with you and what will work. You must have a heck of a good pdoc.
>
> I sure have. ;) No, thanks. And good luck to you.
>Thanks, man. Thanks for talking about 2D6. It's helped me parse things out a bit. I'm apt to say "no more"! But maybe there's something out there for me. Maybe Luvox. Here's to hope!
Posted by Brainbeard on June 23, 2009, at 13:26:45
In reply to Re: Sigh. Abilify is now prescribed. What about Luvox? » Brainbeard, posted by Amelia_in_StPaul on June 23, 2009, at 12:13:45
>> Hmmm...my Mayo report says that fluvoxamine is metabolized by 2D6. I have just done some googling--trusted sources say that it is metabolized by 2D6 but also by 1A2 and 3A4--perhaps the main thing is the multiple pathways, and the fact that it doesn't inhibit 2D6, unlike the other SSRIs. Inhibition is the key for me. It renders me a poor metabolizer.
Quick rection, not much time: they used to think that fluvoxamine was metabolized by 2D6. More recent research has shown that most probably 2D6 is not involved in its metabolization at all. Coul give you research link later.
-Cheers.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.