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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Andrew D on March 3, 2001, at 17:48:32
I've been reading posts on this web site for a few days and have cried at finding people who are having the same kinds of problems I'm having. Thank you for being here!
I'm 28 and have been on and off Prozac (for depression, anxiety, and OCD) since age 20.
--on Prozac from age 20-22 (20 mg/day), starting shortly after the death of my mother (who had been terminally ill most of my life). It worked great except for a few OCD symptoms remained. Went off at 22 because I felt great and wanted to see if I could go it alone.
--went back on at age 25 because I felt miserable and couldn't go it alone. This time I was on 40 mg/day. Still worked great except for a few OCD symptoms remained. Went off it at 26 to try other meds to see if I could get rid of those OCD symptoms. Tried, one after the other, each for a few months: Celexa, Serzone, Effexor, Klonopin (only a week--it knocked me out), Neurontin. Most had no effect at all, and even those that had an effect were pale shadows of what Prozac had been.
--went back on Prozac (40 mg/day) at 27 but it simply didn't seem to work as well as it had. I went off it after a few months and tried the "natural" way--SAMe + Kava Kava. (Also tried adding Buspar but after a few weeks that made me anxious and I had trouble breathing.) I'm generally okay. But the last time I felt really good and happy and able to deal with life was on Prozac the time before last--i.e., 2 years ago.
A brief recap:
20-22 Prozac (20 mg/day)
22-25 nothing
25-26 Prozac (40 mg/day)
26-27 Celexa, Serzone, Effexor, Neurontin, Klonopin
27 Prozac (40 mg/day) "fails", go to SAMe + Kava
28 ???That's the big question--what to do now? It looks like my two most obvious options are:
1. Go back to Prozac, and if it still doesn't do it for me like it did before, augment with naltrexone or amisulpride or something; or
2. Try one of the SSRIs I didn't try before, like Luvox, Zoloft, or Paxil.
I guess I feel like I should do (2), try one of the other SSRIs. Do people think this is the right idea, or should I go back to Prozac since it worked, at least at first?
If Prozac worked (for a while) and Celexa, Effexor, and Serzone failed, are Luvox, Zoloft, and Paxil more likely to work or not to work? Are they chemically "closer" to Prozac than the others?
Does the phenomenon of Prozac not working as well after a hiatus fall under the category of "poop-out"?
Also--has anybody had any experience with Rapid Transcranial Magnetic Stimulation?
In any case--thank you so much for listening, and even more for being there. I really appreciate it. Thank God for the web!
Andrew
Posted by allisonm on March 3, 2001, at 19:02:46
In reply to new here--request for advice, posted by Andrew D on March 3, 2001, at 17:48:32
Andrew,
Since it seems as though you have tried mainly SSRIs and Effexor, has your doctor suggested other non-SSRIs such as Remeron (mirtazapine) or Wellbutrin SR (bupropion) or perhaps an augmentation such as lithium or Wellbutrin to something you have already tried? There are also tricyclics and MAOIs.
I don't know anything about TMS, but if you do a keyword search in the archives, I'm pretty sure there have been multitudinous postings.
Also, if you want, I would suggest visiting Dr. Bob's En-psych-lopedia where you will find at least a couple of algorithms that show the general progression of AD trials for depression (and other illnesses). I have found the Harvard algorithm the most helpful.
Good luck.
Posted by Margit on March 3, 2001, at 22:01:16
In reply to Re: new here--request for advice, posted by allisonm on March 3, 2001, at 19:02:46
Where do you find Dr. Bob's En-psych-lopedia? Reply much appreciated.
Posted by JohnL on March 4, 2001, at 4:27:21
In reply to new here--request for advice, posted by Andrew D on March 3, 2001, at 17:48:32
Hi Andrew,
In your shoes I would handle the situation one of two ways:
1) Try each of the SSRIs for about 2 weeks each. No long trials. If there is a superior match in the bunch, you'll know it early on. You could then choose your favorite to focus on for a longer trial. The trick is convincing your doctor to cooperate. They seem so mythically sold on, and deep rooted, in the long trial thing that it is sometimes hard to explain you just want to sample different drugs before making any longterm commitments to one of them. The short trial thing really works though. Ever wondered what it's like to take the SSRIs you haven't tried? I find it very comforting and even therapeutic to know for sure how I liked each one during a two week trial. Usually they are duds or had bad side effects, but inevitably there is almost always one in the bunch that is great. Never would have discovered it without sampling.
2) Go back to Prozac, but be prepared to add something to it. The top choice as I see it would be small dose Zyprexa. Other excellent choices would be Amisulpride, Risperdal, Adrafinil, Ritalin, or any combination of these. Lithium is probably the most popular add-on in literature, though in the real world it is hard to find anyone doing real well with it. It should though probably be considered. I believe your best odds for success are in the antipsychotic categories and the stimulant categories. If I had to place blind bets for just one top choice, I would go with Zyprexa. Prozac+Zyprexa is an awesome combination for a whole array of different symptoms.
John
Posted by allisonm on March 4, 2001, at 8:48:03
In reply to Re: new here--request for advice - to allisonm, posted by Margit on March 3, 2001, at 22:01:16
If you look at the top of the main PB site, you'll see a teeny-tiny list of hypertext words. One of them says "Links." You'll also find hypertext at the bottom of the PB site for links. Both will take you to Bob's very long list of mental health links < http://www.dr-bob.org/mental.html >, of which the Virtual En-psych-lopedia is one. I misspoke. The algorithm isn't in the en-psych-lopedia; it's in the regular list of links. Here's the address for the algorithm: http://www.mhc.com/Algorithms/
Good luck.
Posted by Neal on March 4, 2001, at 12:27:37
In reply to new here--request for advice, posted by Andrew D on March 3, 2001, at 17:48:32
Andrew -all the above advice is good. I would second the possibilities of Wellbutrin+Remeron, or Effexor+Remeron. Best of luck to you.
Posted by pat123 on March 4, 2001, at 16:39:57
In reply to new here--request for advice, posted by Andrew D on March 3, 2001, at 17:48:32
When you do find what works, I would suggest staying on it for life. More than 1 relapse
tends to indicate this, from what i read and my docs tell me. There is also a risk of a med not being as effective or effective at all if you stop and then restart them. I am all for trying
to stop meds after you have done well for a while
to see if the problems return. If they do I think this is a sign you need them for life.Pat
Posted by JohnX on March 6, 2001, at 2:19:51
In reply to new here--request for advice, posted by Andrew D on March 3, 2001, at 17:48:32
> I've been reading posts on this web site for a few days and have cried at finding people who are having the same kinds of problems I'm having. Thank you for being here!
>
> I'm 28 and have been on and off Prozac (for depression, anxiety, and OCD) since age 20.
>
> --on Prozac from age 20-22 (20 mg/day), starting shortly after the death of my mother (who had been terminally ill most of my life). It worked great except for a few OCD symptoms remained. Went off at 22 because I felt great and wanted to see if I could go it alone.
>
> --went back on at age 25 because I felt miserable and couldn't go it alone. This time I was on 40 mg/day. Still worked great except for a few OCD symptoms remained. Went off it at 26 to try other meds to see if I could get rid of those OCD symptoms. Tried, one after the other, each for a few months: Celexa, Serzone, Effexor, Klonopin (only a week--it knocked me out), Neurontin. Most had no effect at all, and even those that had an effect were pale shadows of what Prozac had been.
>
> --went back on Prozac (40 mg/day) at 27 but it simply didn't seem to work as well as it had. I went off it after a few months and tried the "natural" way--SAMe + Kava Kava. (Also tried adding Buspar but after a few weeks that made me anxious and I had trouble breathing.) I'm generally okay. But the last time I felt really good and happy and able to deal with life was on Prozac the time before last--i.e., 2 years ago.
>
> A brief recap:
>
> 20-22 Prozac (20 mg/day)
> 22-25 nothing
> 25-26 Prozac (40 mg/day)
> 26-27 Celexa, Serzone, Effexor, Neurontin, Klonopin
> 27 Prozac (40 mg/day) "fails", go to SAMe + Kava
> 28 ???
>
> That's the big question--what to do now? It looks like my two most obvious options are:
>
> 1. Go back to Prozac, and if it still doesn't do it for me like it did before, augment with naltrexone or amisulpride or something; or
>
> 2. Try one of the SSRIs I didn't try before, like Luvox, Zoloft, or Paxil.
>
> I guess I feel like I should do (2), try one of the other SSRIs. Do people think this is the right idea, or should I go back to Prozac since it worked, at least at first?
>
> If Prozac worked (for a while) and Celexa, Effexor, and Serzone failed, are Luvox, Zoloft, and Paxil more likely to work or not to work? Are they chemically "closer" to Prozac than the others?
>
> Does the phenomenon of Prozac not working as well after a hiatus fall under the category of "poop-out"?
>
> Also--has anybody had any experience with Rapid Transcranial Magnetic Stimulation?
>
> In any case--thank you so much for listening, and even more for being there. I really appreciate it. Thank God for the web!
>
> AndrewAndrew,
Not sure which root is best. God knows how
many there are.But if you decide to try an
SSRI again I would try Zoloft over Luvox or Paxil.
Zoloft is more activating (energizing) like Prozac and as such may be more likely to mimic the Prozac positives.
Celexa, Paxil, and Serzone are less activating
(generally more sedating). I've noticed a lot of people who get responses from SRI's fall into two classes: Zoloft,Prozac or Paxil/Celexa/Serzone.
Effexor seems to be in a class of its own.I would give Wellbutrin a quick test run before
going the combo roots. Always better to find
a single med before doing the combos. Just my
thoughts.Good luck,
John
This is the end of the thread.
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