![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Lucy_B on September 1, 2015, at 12:30:56
Hi, folks. I apologize in advance for the length of this post! I'm new here and struggling. I was on 20 mg. of generic Prozac (pretty successfully) for about 10 years before tapering off of it about a year ago. I had begun feeling really foggy and thought not being on it might help. Had almost no withdrawal effects and started to feel quite a bit clearer after a month or so. Then, about 6 months later, I started having a myriad of different health issues and have since been diagnosed with a chronic inflammatory bowel disorder. After that, my mental state began to plummet (along with my weight). Finally, my GP recommended that I start on SSRI's again, as I was feeling anxious/depressed more often than not. I began with Celexa, a drug that worked very well for me in my teens/early 20's but which "pooped out" after about 5 years. I started with 10 mg, then went to 15 with plans to achieve 20 eventually, but the side effects were so unbearable (nausea, horrible fear/anxiety, worse diarrhea, insomnia, etc.) that I got spooked and weaned myself back off of it. I was only on it for about 10 days before tapering back down. A few weeks of severe depression/anxiety ensued, then I finally got in to see a psychiatric NP who recommended that I give Prozac another shot. I started with 10 mg. for 3 days, then went up to 20. Getting on the Prozac was easier than the Celexa (except that it completely destroyed my ability to sleep so I had to start taking Trazodone for that). Around 6 weeks or so, there was a point where I thought I might be turning a corner. But now at 8 weeks, I am struggling with extreme anxiety/obsessiveness (mostly about my health), depression/crying on most days, mental fog (i.e. horrible memory, trouble concentrating, feeling like I'm not even there, etc.), no interest in doing anything except scour the internet for health-related stuff, shakiness/night sweats, a few episodes of suicidal ideation, and feeling absolutely terrified of never feeling good again or being able to live a healthy, functional life. I am very worried that both my marriage and job are going to fall apart if I cannot get this under control. I should also add that I've been seeing a fantastic therapist for about 9 months. And I started a round of antibiotics for a recurrent UTI (Cipro) along with probiotics and natural antifungals (oil of oregano) right around the time things started to go downhill again. So that may or may not be having an impact, who knows.
My doc has recommended going up to 40 mg. of the Prozac (along with .5 mg. of Ativan morning and night for anxiety, temporarily). I am concerned that a higher dose might end up being a disaster, as I've read accounts of worsening depression/anxiety when folks jump from 20 to 40. But I've also read about people who didn't have any trouble increasing, which gives me some hope. I would love to hear from those of you who have taken fluoxetine, especially folks who have increased their dose from 20 to 40 mg. I've only ever used 20, and it worked really well for me for a number of years (especially in the beginning). Should I give it a bit more time? I know Prozac is one that can take ages to kick in (I honestly have no recollection of how long it took the first time for me- it's all a blur). My main issue is debilitating worry/anxiety/rumination that feeds into depression, which is perhaps why my doc recommended the increase (apparently Prozac isn't as effective for anxiety at lower doses or something?). In addition to the stuff listed above, I am also severely underweight and concerned that the increase will cause me to lose even more lbs. Can anyone share your thoughts and/or reassurances? I am very grateful for any information I can get!
Posted by phidippus on September 1, 2015, at 13:21:03
In reply to Any success stories with Prozac?, posted by Lucy_B on September 1, 2015, at 12:30:56
I started at 40 mg as a way of aggressively treating my OCD. It did not worsen my mood but did cause panic attacks (which is to be expected when starting an SSRI at a high dose).
>Should I give it a bit more time?
Prozac can take up to 8 weeks to work-pretty much the same amount of time all SSRIs take. When I started at the 40 mg dose, I experienced a change in my OCD symptoms within 6 weeks.
>My main issue is debilitating worry/anxiety/rumination that feeds into depression
Do you have obsessive thoughts that cause you anxiety and depression? If you're having obsessive thoughts, than you have OCD and you need to approach treating your illness from a different angle.
>apparently Prozac isn't as effective for anxiety at lower doses or something?
Untrue. Prozac is effective in treating anxiety at all doses.
>In addition to the stuff listed above, I am also severely underweight and concerned that the increase will cause me to lose even more lbs. Can anyone share your thoughts and/or reassurances?
Prozac is weight neutral. It should not promote weight loss.
I neither gained weight nor lost weight when I was on it.
Eric
Posted by SLS on September 1, 2015, at 14:56:43
In reply to Re: Any success stories with Prozac? » Lucy_B, posted by phidippus on September 1, 2015, at 13:21:03
Your thoughts on Prozac (fluoxetine) and anxiety is sort of right. At the beginning of treatment and perhaps at extremely low dosages, the ability of this drug to block 5-HT2c receptors is more prominent that its ability to inhibit the reuptake of serotonin. This property is unique among the SSRIs. The antagonism of 5-HT2c can produce anxiety, which is why Prozac is likely to be anxiogenic in the beginning. However, once reuptake inhibibion is established, the anxiety usually disappears. It is then often replaced with anxiolytic effects. The bottom line is that one should be prepared for a brief period of increased anxiety in the beginning.
- Scott
Posted by SLS on September 1, 2015, at 15:11:10
In reply to Re: Any success stories with Prozac? » phidippus, posted by SLS on September 1, 2015, at 14:56:43
Posted by phidippus on September 1, 2015, at 15:44:45
In reply to Re: Any success stories with Prozac? » phidippus, posted by SLS on September 1, 2015, at 14:56:43
Some of the initial anxiety caused by SSRIs is due to excessive signaling at 5-HT2C. Reuptake causes this, then receptors downregulate after 1-2 weeks.
In general, it is accepted that 5-HT2C receptor agonists increase anxiety behaviours and induce hypophagia. There is general agreement that antagonists are beneficial anxiolytics.
Eric
Posted by Lucy_B on September 1, 2015, at 16:23:24
In reply to Re: Any success stories with Prozac? » SLS, posted by phidippus on September 1, 2015, at 15:44:45
Thanks so much, everyone! I guess I'm just wondering whether it should have gone away at 8 weeks, and if the fact that it hasn't means I need a dose increase? I'm feeling pretty devastated, as Prozac helped me so much the first go round, but I have no memory of how long it took. My memory is pretty much shot in general, most likely from years of meds. :) I also wonder whether taking a .5 mg Ativan here and there (but not every day) is causing a problem. I swear I feel like it messes with me in the days after I take it. Seems like I'm super sensitive to medications, for some reason. Appreciate all your feedback!
Posted by phidippus on September 1, 2015, at 16:34:48
In reply to Re: Any success stories with Prozac?, posted by Lucy_B on September 1, 2015, at 16:23:24
Please keep in mind if you are having obsessions and your seeking to treat them with Prozac you will need to treat with a minimum of 80 mgs.
Eric
Posted by Lucy_B on September 1, 2015, at 16:43:54
In reply to Re: Any success stories with Prozac? » Lucy_B, posted by phidippus on September 1, 2015, at 16:34:48
> Please keep in mind if you are having obsessions and your seeking to treat them with Prozac you will need to treat with a minimum of 80 mgs.
>
> EricDo you mean "obsession" as in OCD? I definitely worry/ruminate/obsess over stuff, but I attribute that mostly to GAD. I don't have compulsions or rituals. At least not anymore (I did as a child). Unless you count nail biting, compulsively Googling, and (sometimes) blowing my nose constantly. 80 mg seems like a ton...I've never been on a high dose of any AD and the ones that have worked were fantastic (i.e. Celexa and Prozac). Just can't understand why they're not doing it this time around. :(
Posted by SLS on September 1, 2015, at 16:44:26
In reply to Re: Any success stories with Prozac? » SLS, posted by phidippus on September 1, 2015, at 15:44:45
Hi Eric.
> Some of the initial anxiety caused by SSRIs is due to excessive signaling at 5-HT2C. Reuptake causes this, then receptors downregulate after 1-2 weeks.
>
> In general, it is accepted that 5-HT2C receptor agonists increase anxiety behaviours and induce hypophagia. There is general agreement that antagonists are beneficial anxiolytics.My apologies. You are exactly right.
Thanks for intervening.
- Scott
Posted by phidippus on September 1, 2015, at 17:42:32
In reply to Re: Any success stories with Prozac?, posted by Lucy_B on September 1, 2015, at 16:43:54
I suspected OCD because you made mention of searching on medical web sites (I think). It is typical for those who are obsessing on their health to compulsively check medical information on the web. You do not have to have compulsions or rituals to have OCD. Some people just have obsessions or thoughts they can't get out out of their head that kind of torture them. BUT it doesn't sound like you have these kinds of obsessions, so your anxiety is more likely GAD in nature.
The medications may not be working like they once did simply because your stress levels and symptoms are greater than previously. Has antything changed in your life?
Eric
Posted by baseball55 on September 1, 2015, at 18:43:48
In reply to Re: Any success stories with Prozac? » Lucy_B, posted by phidippus on September 1, 2015, at 13:21:03
Inflammatory bowel disease is a very serious condition that can cause all kinds of problems - weight loss, failure to absorb nutrients with any number of consequences. As far as anxiety goes, do you worry about your IBD? Most people do.
I wonder what the connection between your mental health symptoms and your very serious physical health symptoms may be. Have you sat down and talked to your gastro-enterologist?
Posted by Lucy_B on September 1, 2015, at 22:07:05
In reply to Re: Any success stories with Prozac?, posted by baseball55 on September 1, 2015, at 18:43:48
> Inflammatory bowel disease is a very serious condition that can cause all kinds of problems - weight loss, failure to absorb nutrients with any number of consequences. As far as anxiety goes, do you worry about your IBD? Most people do.
>
> I wonder what the connection between your mental health symptoms and your very serious physical health symptoms may be. Have you sat down and talked to your gastro-enterologist?You're absolutely right- I do think that physical health has a ton to do with what's going on right now. They say the gut is our "second brain", after all. And yes, the IBD (and fears about autoimmunity in general) pretty much consume my thoughts. I was trying to control the inflammation with diet and supplements, but no dice. My gastroenterologist has recommended steroids as a next step. Which I am of course terrified to take because of the mental SE's. But I'm not sure I have a choice, as I've lost a lot of weight and am pretty sure my nutrients aren't being absorbed properly.
Posted by Lucy_B on September 1, 2015, at 22:14:17
In reply to Re: Any success stories with Prozac? » Lucy_B, posted by phidippus on September 1, 2015, at 17:42:32
> I suspected OCD because you made mention of searching on medical web sites (I think). It is typical for those who are obsessing on their health to compulsively check medical information on the web. You do not have to have compulsions or rituals to have OCD. Some people just have obsessions or thoughts they can't get out out of their head that kind of torture them. BUT it doesn't sound like you have these kinds of obsessions, so your anxiety is more likely GAD in nature.
>
> The medications may not be working like they once did simply because your stress levels and symptoms are greater than previously. Has antything changed in your life?
>
> EricGood point. And yes, I've had some blows over the past few years that have steadily worn me down. Fortunately, I have a loving husband, a good job/supportive co-workers, and fantastic family/friends. But I've suffered quite a few losses in addition to the IBD diagnosis. And we just sold our house/moved to an apartment (which was insanely stressful), but all of this had started before that happened. I do think I'm experiencing more anxiety/stress now than I was when I first started meds years ago. So you are probably right. Do you think I should increase my dosage?
Posted by rjlockhart37 on September 1, 2015, at 23:47:39
In reply to Any success stories with Prozac?, posted by Lucy_B on September 1, 2015, at 12:30:56
I've been on Prozac since 2005, i noticed it's effect slightly at 20mg the first couple months of it's start up. When it was raised to 40mg i could tell a differnce but it also made me int a mild hypomanic state, i was in better mood but everything seemed like prozac pop feeling and my social anxiety was lessened .... then after the years went by my mind kinda regulated to the effect and it was less notiable, yet i didnt get depressed, but i don't get that prozac up beat feeling about everything.......i think the mind adapts to a change, im not depressed, but im not on a prozac mood roll like i was in 05-08
It's a good med, it's activating and lessens anxiety (in some people)
Posted by rjlockhart37 on September 1, 2015, at 23:52:26
In reply to Re: Any success stories with Prozac?, posted by rjlockhart37 on September 1, 2015, at 23:47:39
ask about increasing to 40mg, it had a difference in me when it was increased to that......everythings differnt for people, prozac could work well with you for a long time, it's all with the person's nuero structure, but i notice im not in a pit fall mood, it keeps it slightly at bay and normal, but i've taken it a long time nearly 10 years and i've been used to it's effect for a long time......
but prozac made me peppy when i started it at 40mg
Posted by Horse on September 2, 2015, at 0:13:03
In reply to Any success stories with Prozac?, posted by Lucy_B on September 1, 2015, at 12:30:56
An angle suggested by op would be to consider your fogginess that caused you to discontinue Prozac as a symptom of increasing inflammation later dx'd as ibd. Maybe the reason Prozac seems less effective is that its anti inflammatory properties are being asked to do more. I agree that you may want to discuss this w/ your gastrointestologist. Best wishes.
Posted by SLS on September 2, 2015, at 1:35:04
In reply to Re: Any success stories with Prozac? » phidippus, posted by Lucy_B on September 1, 2015, at 22:14:17
I don't have OCD, but I have been highly motivated to spend huge amounts of time researching many different medical resources in an effort to find an answer to successfully treat my illness that my doctors have thus far been unable to. Is this an obsession? Perhaps it is an obsession according to some popular non-psychiatric definitions. I do know that it is not due to having OCD. I am just very focused on the task at hand and am determined to feel better and function effectively. I just want my health. The day I find myself feeling well is the day I no longer have to conduct medical research. One of the dimensions of OCD is that it necessarily interferes with functioning on a day-to-day basis. I don't have anxiety caused by intrusive and unwelcomed obsessional thoughts.
I think Eric (Phidippus) is right about your having OCD, but I think it deservers a more detailed exploration of your symptoms and behaviors by a psychiatric specialist to make a definitive diagnosis and separate out anxiety and depression as possible comorbidities. As I'm sure Eric will tell you, it is usually necessary to use higher dosages of SSRIs and wait longer in order for an improvement in this condition to emerge.
Just a thought on the OCD, depression, anxiety, and IBD... All of these conditions are treatable to some degree by taking clomipramine (Anafranil). Clomipramine is a tricyclic with potent serotonin reuptake inhibition. Perhaps one drug will hit all of these targets for you. That would be convenient, but it is not really so important that you find one single drug to attain your health. I take six for bipolar depression alone. In any event, clomipramine does not come without side effects - most of which are anticholinergic. There are a few studies that suggest clomipramine has anti-inflammatory properties similar to fluoxetine. Tricyclics in general have demonstrated the ability to improve inflammatory bowel disease as well as irritable bowel syndrome. SSRIs have been disappointing.
- Scott
Posted by Lucy_B on September 2, 2015, at 12:28:06
In reply to Re: Any success stories with Prozac? » Lucy_B, posted by Horse on September 2, 2015, at 0:13:03
Thanks so much, folks! I'm glad to hear that at least one person had a positive experience upping from 20 to 40 mg. of Prozac. And Horse, I believe you are correct that inflammation is a huge factor here. For a long time, I focused just on that by taking loads of turmeric, fish oil, probiotics, etc. When that didn't do the trick, I decided it was time to go back on meds. I've read several studies suggesting that Prozac works by reducing inflammation, which I feel is why it was so effective for me the first time I took it. But I may very well need a bit more this go round. Gonna bite the bullet and increase the dose...please wish me luck and sanity. :) I feel so relieved to have found a place where I can come to connect with others who have had similar experiences. It really does help to have a community like this.
Posted by Hugh on September 2, 2015, at 18:55:52
In reply to Re: Any success stories with Prozac? » baseball55, posted by Lucy_B on September 1, 2015, at 22:07:05
> My gastroenterologist has recommended steroids as a next step. Which I am of course terrified to take because of the mental SE's. But I'm not sure I have a choice, as I've lost a lot of weight and am pretty sure my nutrients aren't being absorbed properly.
Before trying steroids, you might want to give low dose naltrexone (LDN) a try.
http://www.lowdosenaltrexone.org/
https://sites.google.com/site/dudleyslowdosenaltrexonesites/home
Posted by Chris O on September 3, 2015, at 3:36:51
In reply to Any success stories with Prozac?, posted by Lucy_B on September 1, 2015, at 12:30:56
Hi, Lucy:
For what it's worth, I was on the brand name Prozac 20mg a day for about a year in 1998-1999, and it had a clinically significant effect (though not as much as I would have liked) on my anxiety and depression. However, when I tried to go back on Prozac (the generic version) in 2006-2007, even in doses of 80-100mg, I experienced little of anything clinically significant. Often, it felt like I was taking nothing, even at that high of a dose. So, go figure. I would say 40mg is definitely worth a try, especially if 20mg isn't working anymore. I don't think you have anything to lose.
Chris
Posted by Hugh on September 4, 2015, at 10:19:08
In reply to Any success stories with Prozac?, posted by Lucy_B on September 1, 2015, at 12:30:56
Have you tried D-mannose or any of these other treatments for your recurrent UTI?
http://articles.mercola.com/sites/articles/archive/2014/04/28/d-mannose-uti-prevention.aspx
http://www.digitalnaturopath.com/cond/C118881.html
There's a growing consensus that glutamate has more to do with depression, anxiety, and OCD than serotonin.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205453/
https://iocdf.org/expert-opinions/expert-opinion-glutamate/
Posted by Lucy_B on September 4, 2015, at 10:56:47
In reply to Re: Any success stories with Prozac? » Lucy_B, posted by Hugh on September 4, 2015, at 10:19:08
> Have you tried D-mannose or any of these other treatments for your recurrent UTI?
>
> http://articles.mercola.com/sites/articles/archive/2014/04/28/d-mannose-uti-prevention.aspx
>
> http://www.digitalnaturopath.com/cond/C118881.html
>
> There's a growing consensus that glutamate has more to do with depression, anxiety, and OCD than serotonin.
>
> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205453/
>
> https://iocdf.org/expert-opinions/expert-opinion-glutamate/
>
>Hi, Hugh! Yep, I've tried the d-mannose. It works well, but the high doses needed for therapeutic value to treat an active infection intensified my IBD symptoms so much that I had to stop. I started taking high doses of oregano oil and colloidal silver instead. But those made me feel HORRIBLE after about 7 days (heightened anxiety, racing heart, depression, muscle/joint pains, you name it), and the infection was still hanging on. So I finally bit the bullet with Cipro. Just took my last pill a couple days ago and I feel worlds better after having discontinued it. Seems like anything that attacks pathogens in my body (be it natural or pharmaceutical) leads to major physical/mental symptoms, which probably means I have lots to kill off. ;-) At any rate, thanks for this, and the info re: LDN. I was not aware of that treatment.
Posted by Lucy_B on September 4, 2015, at 10:59:10
In reply to Re: Any success stories with Prozac? » Lucy_B, posted by Chris O on September 3, 2015, at 3:36:51
> Hi, Lucy:
>
> For what it's worth, I was on the brand name Prozac 20mg a day for about a year in 1998-1999, and it had a clinically significant effect (though not as much as I would have liked) on my anxiety and depression. However, when I tried to go back on Prozac (the generic version) in 2006-2007, even in doses of 80-100mg, I experienced little of anything clinically significant. Often, it felt like I was taking nothing, even at that high of a dose. So, go figure. I would say 40mg is definitely worth a try, especially if 20mg isn't working anymore. I don't think you have anything to lose.
>
> ChrisGood to know. I've heard that generics can be much less effective than brand. Wish my insurance would pay for real Prozac!
Posted by phidippus on September 4, 2015, at 21:51:58
In reply to Re: Any success stories with Prozac? » phidippus, posted by Lucy_B on September 1, 2015, at 22:14:17
>Do you think I should increase my dosage?
I'm sorry your stress has increased. Increasing your dosage of Prozac may help you cope better with issues of stress by further lowering your anxiety and helping with depressive issues. If you still do not respond to higher dose of prozac then I would investigate other antidepressants.
Eric
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.