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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by pajoco on May 10, 2008, at 12:32:33
I've been taking prozac for depression and agoraphobia for about 14 years, and it's been wonderful. Lately I've been experiencing mood swings and depression, (after the death of my mother-in-law, and some serious health issues for my husband of 35 years) and my doctor has suggested switching to Effexor. I'm leary of switching, but can't stand being in this depression. Any suggestions?
Posted by Phillipa on May 10, 2008, at 12:38:51
In reply to Prozac burn-out, posted by pajoco on May 10, 2008, at 12:32:33
Is there any change it could be the shock and that it might again work when you deal with it have seen a therapist? Just a suggestion other than that your pdoc knows you the best. Good luck Phillipa
Posted by Phillipa on May 10, 2008, at 12:39:54
In reply to Re: Prozac burn-out » pajoco, posted by Phillipa on May 10, 2008, at 12:38:51
Also see your new to babble welcome and hope you find some answers here. Love Phillipa
Posted by Forerunner on May 10, 2008, at 13:58:25
In reply to Prozac burn-out, posted by pajoco on May 10, 2008, at 12:32:33
> I've been taking prozac for depression and agoraphobia for about 14 years, and it's been wonderful. Lately I've been experiencing mood swings and depression, (after the death of my mother-in-law, and some serious health issues for my husband of 35 years) and my doctor has suggested switching to Effexor. I'm leary of switching, but can't stand being in this depression. Any suggestions?
I would listen to your Doc and switch.
Posted by Racer on May 10, 2008, at 22:17:53
In reply to Prozac burn-out, posted by pajoco on May 10, 2008, at 12:32:33
Effexor is a very effective drug for many people. It may be a very good choice for you, and it's worth trying it if the Prozac isn't giving you the relief you need right now.
There's another, newer drug in the same class called Cymbalta, but there's less experience with it because it's only been on the market for about four years, and it's not available as a generic -- which I think Effexor is now? -- so depending on your reservations about Effexor, that might also be an option for you.
Can you identify your reservations about Effexor? Is there any reason you're not uncomfortable with the idea of switching?
Good luck, whatever you decide to do.
Posted by pajoco on May 11, 2008, at 9:37:09
In reply to Re: Prozac burn-out » pajoco, posted by Racer on May 10, 2008, at 22:17:53
Thanks to everyone for your help. I'm leary of the Effexor because I went through an awful time several years ago (pre-prozac) when I was on Xanax and Clonapine in high doses, and was told to just stop taking it when I had a bad reaction. Hoooo, boy - don't want to go through that again. Everything I'm reading about the Effexor says that it's REALLY hard to get off of, so if it doesn't work, I'll have a double wammy. My doc knows how I feel, and says we can try to supplement the Prozac with Omega 3, or perhaps a thyroid med, if I want to try that first. Just torn about what to do. Thought I was set for the rest of my life since the prozac worked so well - literally set me free - so even more depressed about that.
Anyway, glad I found you all - and thanks again for your advice.
Posted by Racer on May 11, 2008, at 10:28:59
In reply to Re: Prozac burn-out, posted by pajoco on May 11, 2008, at 9:37:09
Yes, Effexor is known for a wicked discontinuation syndrome. The good news is that you shouldn't have much problem if you take it for the two to three months it would take to titrate up to a therapeutic dose and see how it works. My husband tried it and had no trouble coming off when it didn't work out for him.
The other good news is that Cymbalta is related and has a much milder withdrawal for most people. (It took me eight months to get off Effexor after a couple of years -- although I could probably have done it more quickly, looking back -- and only a couple of weeks on the Cymbalta. And there were no problems at all with stopping the Cymbalta -- it only took the weeks because I didn't want to risk any problems.
They're both good medications. My pdoc suggested trying Effexor again recently, because he considers it reliably effective for most of his patients. (And I happen to think he's a genius -- and I'm very hard to please.)
I wish you very good luck. I do think it's worth trying another medication. If neither Effexor nor Cymbalta are options, it's also worth trying Zoloft -- sometimes switching to another drug in the same class will be effective when one poops out on you.
Posted by pajoco on May 11, 2008, at 11:37:31
In reply to I wondered if that was it » pajoco, posted by Racer on May 11, 2008, at 10:28:59
Thanks again...My doctor didn't mention Cymbalta, although he, too, is a genious! I'll bring it up when I talk to him again. I gained alot of weight on the Prozac (which doesn't make my husband happy) - do both Cymbalta and Effexor cause weight gain, also?
Posted by pajoco on May 11, 2008, at 11:38:42
In reply to I wondered if that was it » pajoco, posted by Racer on May 11, 2008, at 10:28:59
One more question - do I have to go off the Prozac before I can start taking either of these meds, or will I just be able to switch??
Thanks!
Posted by Racer on May 11, 2008, at 12:20:44
In reply to Re: I wondered if that was it, posted by pajoco on May 11, 2008, at 11:38:42
Whether you can just switch will depend on your doctor -- in theory, a cross taper would be just fine, but sometimes the doctors want to taper way down first.
ANY medication which affects serotonin reuptake can cause weight gain. Whether any specific medication will cause weight gain in any specific patient is a whole 'nother story. The good news is that both Effexor and Cymbalta also affect norepinephrine, which can help reduce that tendency. Frankly, between the two, I'd go for Cymbalta any day of the week and twice on Sundays. For me, it had far fewer adverse effects, and I think it caused somewhat less weight gain -- although I should mention I was on it during treatment for Anorexia Nervosa, so I did gain fifty pounds while taking it. I have no clue how much of that was the medication, and how much was eating.
Anyway, I do wish you the best -- it's hard to find a medication which balances effectiveness and tolerability. I wish you luck with whatever you choose.
Posted by undopaminergic on May 11, 2008, at 14:09:26
In reply to Re: Prozac burn-out, posted by pajoco on May 11, 2008, at 9:37:09
> My doc knows how I feel, and says we can try to supplement the Prozac with Omega 3, or perhaps a thyroid med, if I want to try that first. Just torn about what to do. Thought I was set for the rest of my life since the prozac worked so well - literally set me free - so even more depressed about that.
>It's not a bad idea to try to augment the Prozac with supplements and drugs. Lithium augmentation is often effective (and at lower doses than those needed for bipolar); if you try this, it may be a particularly good idea to also add some thyroid hormone and omega-3 oils, as lithium can impair thyroid function, and some doctors think omega-3 helps reduce some of the potential adverse effects of lithium. Other options for supplementation are serotonin precursors - tryptophan or 5-hydroxytryptophan (5-HTP) to be precise. Other useful add-ons are stimulants, such as methylphenidate (Ritalin, Concerta) and amphetamines (Adderall, Dexedrine); they often have a mood-elevating effect and also commonly promote weight loss.
If you decide to switch, I think Zoloft (sertraline) would be a logical choice, as you have responded very well to Prozac, and Zoloft is a more potent drug that belongs to the same class of medication, SSRIs. After that, Effexor or Pristiq (a newer, slighly improved version of Effexor that is new more expensive) would seem the most logical choices. Alternatively, addition of Strattera (atomoxetine) to Prozac or Zoloft could be tried, and a further alternative is Cymbalta (duloxetine).
Posted by Racer on May 11, 2008, at 14:14:51
In reply to Re: Prozac burn-out, posted by undopaminergic on May 11, 2008, at 14:09:26
> Alternatively, addition of Strattera (atomoxetine) to Prozac or Zoloft could be tried, and a further alternative is Cymbalta (duloxetine).
That's a good idea about Strattera, but I'd like to point out that it's contraindicated with Prozac. It's said to be fine with other SSRIs, and I don't know why it's contraindicated with Prozac, but felt I should point out that it was.
Posted by undopaminergic on May 11, 2008, at 16:22:36
In reply to Very short note on that... » undopaminergic, posted by Racer on May 11, 2008, at 14:14:51
> > Alternatively, addition of Strattera (atomoxetine) to Prozac or Zoloft could be tried, and a further alternative is Cymbalta (duloxetine).
>
> That's a good idea about Strattera, but I'd like to point out that it's contraindicated with Prozac. It's said to be fine with other SSRIs, and I don't know why it's contraindicated with Prozac, but felt I should point out that it was.
>I didn't remember, but the reason is that fluoxetine (Prozac) inhibits the liver enzyme CYP2D6, which metabolises atomoxetine. The combination is not contraindicated, but downward dose adjustment of Strattera is necessary.
Posted by Racer on May 11, 2008, at 18:39:34
In reply to Re: Very short note on that..., posted by undopaminergic on May 11, 2008, at 16:22:36
> > > > I didn't remember, but the reason is that fluoxetine (Prozac) inhibits the liver enzyme CYP2D6, which metabolises atomoxetine. The combination is not contraindicated, but downward dose adjustment of Strattera is necessary.
Thank you! I learned something new, and I appreciate it.
Posted by KarenRB53 on May 12, 2008, at 12:11:56
In reply to Prozac burn-out, posted by pajoco on May 10, 2008, at 12:32:33
> I've been taking prozac for depression and agoraphobia for about 14 years, and it's been wonderful. Lately I've been experiencing mood swings and depression, (after the death of my mother-in-law, and some serious health issues for my husband of 35 years) and my doctor has suggested switching to Effexor. I'm leary of switching, but can't stand being in this depression. Any suggestions?
I've also been on Prozac for many years and it helped me tremendously but now it seems to have stopped working for me. My pdoc wants me to try adding Wellbutrin to see if that helps. I'm taking Omega's and they haven't seemed to make a difference. Please let me know how you make out and what you decide to try. I'll also let you know how adding the Wellbutrin works.Karen
Posted by KarenRB53 on May 12, 2008, at 12:16:00
In reply to Re: Prozac burn-out, posted by KarenRB53 on May 12, 2008, at 12:11:56
> > I've been taking prozac for depression and agoraphobia for about 14 years, and it's been wonderful. Lately I've been experiencing mood swings and depression, (after the death of my mother-in-law, and some serious health issues for my husband of 35 years) and my doctor has suggested switching to Effexor. I'm leary of switching, but can't stand being in this depression. Any suggestions?
>
>
> I've also been on Prozac for many years and it helped me tremendously but now it seems to have stopped working for me. My pdoc wants me to try adding Wellbutrin to see if that helps. I'm taking Omega's and they haven't seemed to make a difference. Please let me know how you make out and what you decide to try. I'll also let you know how adding the Wellbutrin works.
>
I forgot to mention that I did try the Effexor, after tapering off the Prozac about 6 months ago and it did not work for me. Made my blood pressure to up and made me agitated. But everyone is so different it may work well for you. Also, if adding the Wellbutrin doesn't work my doctor has suggested the Cymbalta.Karen
>
Posted by pajoco on May 12, 2008, at 20:15:19
In reply to Re: Prozac burn-out, posted by KarenRB53 on May 12, 2008, at 12:11:56
I tried Welbutrin a few years ago to try to control the weight gain, but it just made me feel agitated, so I stopped. Just had a thyroid work-up, and when the results come in, I'll be seeing the doc again, and we'll see what he says. I have so much more information now that I've found this site. Thanks to everyone for all your help!!!
Posted by bearfan on May 14, 2008, at 17:50:32
In reply to Re: Prozac burn-out, posted by pajoco on May 12, 2008, at 20:15:19
Are you on a standard dosage of Prozac? Perhaps a slight dosage increase will help you get through. If you are not having sexual or weight problems with the prozac, than probably just a dose increase will help. I've read a pharmacology report and it stated Prozac has a weak effect on norepinephrine rather than being a strict 'SSRI'.
Posted by bearfan on May 14, 2008, at 17:52:55
In reply to Re: Prozac burn-out, posted by bearfan on May 14, 2008, at 17:50:32
I forgot to mention that the SNRI's usually have more side effects than the other common SSRIs. Many people experienced bloating and weight gain on Cymbalta. Lexapro would also be an option
Posted by hitman60 on May 15, 2008, at 5:38:51
In reply to Prozac burn-out, posted by pajoco on May 10, 2008, at 12:32:33
I took Prozac once for three years and then I switched to Serzone, but my shrink took me off that after 2 years because of liver issues that were reported. So I went back to Prozac. Like you it started to lose its potency, but I did NOT want to switch, so I got off slowly.
One year later, I thought perhaps I was a bit depressed- seasonal affective stuff, so the doc said try Prozac again. I had lost 30 pounds, was running 4 miles a day and doing good stuff for my body. After 5 dozes, I experience serotonin surge, and was sweaty, anxious, paranoid and agitated to the max. He told me to stop immediately. The explanation was since I was exercising so intently I had probably built up my serotonin level, coupled with the wt loss and my body did NOt need serotonin.Point is those SSRI's can be tricky. I am finished with them. My big problem now is tapering off this .5 mg of Klonopin..what a bitch that is!
This is the end of the thread.
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