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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Michael Schell on December 2, 1998, at 10:58:18
I have run the gamut with the SSRI drugs without finding the perfect fit. So far Prozac made me feel the best, but I had many sexual dysfunctions as well as anxiety, fatigue, tiredness and headaches. Luvox was O.K., but I still had sexual dysfunctions, although not as bad, and all of the other side effects with even more tiredness. My overall feeling on Luvox wasn't nearly as good (i.e., the antidepressant effect wasn't as good). I also seemed to be kind of mean to people on the Luvox, not really caring about anyone's feelings. On Paxil I seemed to have the least amount of side effects overall, but 2 of them were unbearable. I had a feeling of being spacy - kind of mentally foggy and extemely tired all the time. Effexor XR made me more nervous than ever and had a lot of sexual side effects. I've tried adding Wellbutrin to Luvox & prozac, but both times it gave me an uncomfortable level of anxiety and seemed to exacerbate my OCD. While I've been taking all the medications, I have also been taking 25mgs of Trazadone to sleep (less than 25mgs with Prozac) and Buspar 20 mgs to fight off the sexual side effects (hasn't helped much if any) & to reduce my anxiety level and agitation I get on these drugs (it has help at least a little). I've gone back to Luvox for about 4 weeks and pretty much the same effects as the first time, so I've added in Ritalin. I've been taking 5mgs of Ritalin twice daily for 4 days now. So far it does help with the fatigue but I still feel drowsy. When I first take it I feel a little dizzy, I also crash after it wears off and my nervousness has gotten a little worse. I also suffer from apathy on these drugs, and the Ritalin hasn't helped much to alieviate that. However, I do feel more alert and a little faster at getting things done at work. The condition I'm being treated for is moderate OCD. All of the SSRI's have been helpful at relieving a lot of my Obssessive-Compulsive symtoms. I am pretty medication sensitive and have taken a lower than normal level of these meds for my disorder. I've been on a max of 20mg Prozac, 40mg Paxil, 100mg Luvox and 150mg Effexor XR. I have decided to take the plunge into the new SSRI in this country called Celexa. I'm going to continue on the 5mg twice daily of Ritalin although I would rather be on Adderall or Dexadrine from all the things I've read. My doctor is hesitant to put me on Adderall because he feels it is more addicting than Ritalin. He also wont even consider Dexadrine cause he says it is extemely addicting. What are your thoughts? Also, I've read that while taking Ritalin you must avoid food and drinks containing tyramin. Is this true? Is the same true for Adderall or Dexadrine? What are your thoughts on my purposed new regimen of Celexa 20mgs, BuSpar 20mgs, Ritalin 10mgs & Trazadone 25mgs? I'd also like to know when the best time to take Celexa would be - in the morning or at night? Also, if I did substitute Adderall for Ritalin how do I transition from one to the other? Must I get off the one completly or can I just switch over? I realize that I've gone on and on, but I really do need some help and I feel that your web site is the only place to get helpful perspectives other than my doctor's. I greatly appreciate your time and consideration on my matters at hand. Thanks in advance for all responses.
Feel free to e-mail me at Michael.Schell@infores.com
Posted by Toby on December 3, 1998, at 16:16:02
In reply to My history & advice needed from Toby, Dr. Bob, etc, posted by Michael Schell on December 2, 1998, at 10:58:18
Ever been on Anafranil? Just a thought.
Switching from one stimulant to another requires no tapering or complicted switchover... just stop one one day and start the other the next.
Sometimes a stimulant is enough to take away the sexual side effects without buspar. Other things to try for the sexual side effects are L-arginine 2000 mg 2 hours before intercourse, periactin 2-8 mg 2 hours before intercourse, or a drug holiday (stop the medication on Friday, have your "date" on Saturday, and restart the medication on Sunday).
Stimulants are addicting to addicts. However, if you do not use ilicit substances and have not ever done so, it is unlikely you will abuse a medication given to you for therapeutic reasons. A slightly different alternative to the major stimulants might be to use fenfluramine which will boost the serotonin and possibly help the OCD while also helping with the fatigue. Yes, this is part of that controversial weight loss combo, but used alone there has never been a problem with it. Tell your doctor to look it up in the literature. Fenfluramine is a good augmenting agent for OCD.
No dietary restrictions on the stimulants.
If you do switch to Celexa, you may not need the buspar (if you are really only using it for the sexual side effects) as I understand from many patients that it hasn't been causing that like the others do; on the other hand, some say it causes it as well. Since Celexa is an SSRI just like all the other things you've been on, my hope for a difference is small (sorry, I'm raining on this). However, I don't see that you have been tried on Zyprexa (which some say has helped their sleep and yet helped their energy, too; one patient I have is now out in the yard doing things he hasn't been able to do in several years). That may be an alternative.
Posted by Michael Schell on December 7, 1998, at 12:30:40
In reply to Re: My history , posted by Toby on December 3, 1998, at 16:16:02
> I've never been on Anafranil, but I've heard some horrible things regarding side effects. Not sure I want to give it a try. I have looked into Zyprexa for the increase in dopamine effect, but my doctor seemed to believe that it doesn't increase dopamine. My doctor said that it is a dopamine blocker, so it wouldn't compensate for the loss of dopamine that the SSRI's can cause.
What are your thoughts on this? If I did go this route, would Zyprexa take the place of Trazadone and BuSpar? What does should I take? 2.5 mgs. or 5 mgs.? How bad is the weight gain caused by Zyprexa?
>I've also thought about replacing the BuSpar that I take with one of the Beta-blockers: either Pindolol or Lopressor. I thought these would help the anxiety and headaches I get from the SSRI's as well as potentiating their effects. Do you have any suggestions as to which is better? and Do you think this is a good idea?
>The one thing that scares me about your recommendation of taking Fenfluramine is the few reports I've seen saying that this drug decreases the amount of serotonin that your brain can produce over the long term. Is this a substantiated belief or just a miscellaneous report? I've also seen a similar report regarding long term use of Ritalin.
Posted by Toby on December 10, 1998, at 16:15:10
In reply to Re: Thanks Toby, I've still got a few more ???'s , posted by Michael Schell on December 7, 1998, at 12:30:40
Zyprexa actually causes a round-about boosting of serotonin (but in ways I can't begin to explain in any way that makes sense, what with me being a clinician and not a researcher) and that's the effects we're looking for, not necessarily a specific dopamine effect. The dose to start with is usually 2.5 but then gradually increasing up to 20 mg or so. The weight gain varies among different people between none and 5-10 pounds although I have heard tell of 15-20 pounds (just never had any of my patients gain that much).
I like pindolol best because it too has a serotonin boosting effect and I don't see much in the way of drastic drops in blood pressure. I have seen only one good report on Buspar augmentation for OCD but some clinicians say it does well. If you have been on it over 6 months with no benefit, a change to something else for the anxiety may be in order.
The stimulants don't appear to reduce serontonin in the long run. Otherwise you'd have a lot of ADD kids running around without any serotonin.
This is the end of the thread.
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