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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 kreedi on March 8, 2002, at 23:31:31
I stopped taking Paxil after 10 days, because even the low dose, 10 mg, was pretty much completely inhibiting my ability to reach orgasm.
On my last visit to my psychiatrist -- supposedly THE best in the non-US city where I live -- said, with distinct annoyance, "You can do the therapy on your own, leave the psychopharmacology to me." So I continued, for a while anyway, with the Paxil, despite the aforementioned side effect.
I'm not sure I'm feeling all that depressed any more, in the despairing sense -- more like a kind of listless numbness, lack of enthusiasm, motivation.
Should I try Celexa? -- with or without the pdoc's approval? God knows I've read enough about dosage and side effects, here and elsewhere (it helps, too, that my mother is a physician and my dad a pharmaceuticals executive).
One complication: after a potentially unsafe sexual encounter last week, I started PEP, or Post Exposure Prophylaxis. Two anti-HIV drugs (AZT/ZDV and 3TC) taken twice a day, for 28 days. One more physical -- and psychological -- problem to deal with. Does anyone know of potential interactions with psychotropic medications? MOST importantly, should I wait until the PEP is done (end-March) before loading my body with another chemical, or begin right away (given the long depressive episode, December through February)?
Confused, Kreedi
Posted by JohnX2 on March 8, 2002, at 23:50:59
In reply to Paxil to Celexa; bad Pdocs; HIV drug interactions, posted by kreedi on March 8, 2002, at 23:31:31
Hi Kreedi,As far as your pdoc goes, many psychiatrists are very
focused at medication and are very skilled at what they do.
They have many years of medical training, etc. but do little
therapy. A good psychiatrist will listen carefully to your
psychiatric sympomts in the time allotted and pick out medications
best tailored to treat your symptoms. Mosts medications have
trade offs/side effects that wear off over time. If there is
something that you absolutely cannot stand about a medication
then it is important to communicate it back to your pdoc. If
he is good, you can call him, and he will be responsive and
return your call. In the case of sexual dysfunction, if this
really is bothering you, there are other medications that are
less likely to cause this but you may trade it off for other
side effects. Also, the sexual dysfunction side effect may wear
off by itself over time anyways. Most importantly, its best
to get yourself mentally healthy and decide where to go from
there. But you need to work with your pdoc on these physical
ailments. A lot of good pdocs just aren't big into talk
therapy (but they darn well better be responsive to
your medical concerns).Psychotherapists on the other hand have lots of time
doing therapy (cognitive therapy, etc) and are well schooled in
psychology. I personally am in the school of thought that
it is good to have *both* a well recommended psychopharmacologist
and a well recommended pschotherapist. Unfortunately I don't
think there is a good psychopharmacologist and
psychotherapist rolled into 1 package. And if there
is, you probably are going to have a hard time getting
an appointment.Best of luck,
John
> I stopped taking Paxil after 10 days, because even the low dose, 10 mg, was pretty much completely inhibiting my ability to reach orgasm.
>
> On my last visit to my psychiatrist -- supposedly THE best in the non-US city where I live -- said, with distinct annoyance, "You can do the therapy on your own, leave the psychopharmacology to me." So I continued, for a while anyway, with the Paxil, despite the aforementioned side effect.
>
> I'm not sure I'm feeling all that depressed any more, in the despairing sense -- more like a kind of listless numbness, lack of enthusiasm, motivation.
>
> Should I try Celexa? -- with or without the pdoc's approval? God knows I've read enough about dosage and side effects, here and elsewhere (it helps, too, that my mother is a physician and my dad a pharmaceuticals executive).
>
> One complication: after a potentially unsafe sexual encounter last week, I started PEP, or Post Exposure Prophylaxis. Two anti-HIV drugs (AZT/ZDV and 3TC) taken twice a day, for 28 days. One more physical -- and psychological -- problem to deal with. Does anyone know of potential interactions with psychotropic medications? MOST importantly, should I wait until the PEP is done (end-March) before loading my body with another chemical, or begin right away (given the long depressive episode, December through February)?
>
> Confused, Kreedi
Posted by Bekka H. on March 9, 2002, at 0:46:22
In reply to Paxil to Celexa; bad Pdocs; HIV drug interactions, posted by kreedi on March 8, 2002, at 23:31:31
Celexa is supposed to cause fewer drug-drug interactions than some of the other SSRIs, but it MIGHT still cause sexual problems. Most of the SSRIs cause sexual dysfunction.
As for whether you should hold off taking an antidpressant until your other med regimen is over, I would probably hold off, but I think you have to decide that. If you're really depressed, it might be a good idea to stay on AD's. If you're only mildly depressed, then maybe it's ok to wait. I understand that some of those anti-HIV meds have a lot of drug interactions, but I don't know the details.
Posted by Sunnely on March 9, 2002, at 22:10:38
In reply to Paxil to Celexa; bad Pdocs; HIV drug interactions, posted by kreedi on March 8, 2002, at 23:31:31
Can't tell you what antidepressants you should take. You should discuss this with your doctor.
Citalopram (Celexa) is a substrate of CYP3A4 and CYP2C19. The following HIV drugs are inhibitors of CYP3A4 and may increase Celexa's blood level and lead to increase side effects:
A. Nonnucleoside reverse transcriptase inhibitors: 1. delavirdine (Rescriptor) potent, 2. efavirenz (Sustiva) potent, 3. nevirapine (Viramune) moderate.
B. Protease Inhibitors: 1. indinavir (Crixivan) potent, 2. ritonavir (Norvir) potent, 3. lopinavir/ritonavir (Kaletra) moderate, 4. amprenavir (Agenerase) moderate, 5. nelfinavir (Viracept) moderate, 6. saquinavir (Fortovase, Invirase) moderate.
> I stopped taking Paxil after 10 days, because even the low dose, 10 mg, was pretty much completely inhibiting my ability to reach orgasm.
>
> On my last visit to my psychiatrist -- supposedly THE best in the non-US city where I live -- said, with distinct annoyance, "You can do the therapy on your own, leave the psychopharmacology to me." So I continued, for a while anyway, with the Paxil, despite the aforementioned side effect.
>
> I'm not sure I'm feeling all that depressed any more, in the despairing sense -- more like a kind of listless numbness, lack of enthusiasm, motivation.
>
> Should I try Celexa? -- with or without the pdoc's approval? God knows I've read enough about dosage and side effects, here and elsewhere (it helps, too, that my mother is a physician and my dad a pharmaceuticals executive).
>
> One complication: after a potentially unsafe sexual encounter last week, I started PEP, or Post Exposure Prophylaxis. Two anti-HIV drugs (AZT/ZDV and 3TC) taken twice a day, for 28 days. One more physical -- and psychological -- problem to deal with. Does anyone know of potential interactions with psychotropic medications? MOST importantly, should I wait until the PEP is done (end-March) before loading my body with another chemical, or begin right away (given the long depressive episode, December through February)?
>
> Confused, Kreedi
This is the end of the thread.
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