Posted by med_empowered on July 27, 2005, at 4:18:04
In reply to Re: What all R U taking ?, posted by rjlockhart98 on July 25, 2005, at 20:24:12
hey. 2.5 mgs of Zyprexa isn't bad...although I developed akathisia on that dose, thats pretty rare...some people report a "bump" in antidepressant efficacy when they add Zyprexa or other atypicals at lower end dosages. The Prozac probably will take a few weeks to work, assuming it does work. If you're panic-prone, though, Prozac is a kind of odd choice; it has a tendency to make a lot of people more anxiety prone. Its also not terribly potent, so you need more of it to get the same reuptake-inhibition you'd get from lower doses of other drugs. Finally, it has a freakishly long half-life, which is nice for reducing withdrawal problems, but can be a pain if you have a bad reaction. The Klonopin is a little bit high; clonazepam does have a tendency to deepen or cause depression in some people, although it can be beneficial to some others. At any rate, most research puts the "ideal dose" of Klonopin at, at most, 3mgs/day. (For most people...you may very well be the exception to this rule). What I think might work a little better would be switching to an antidepressant that either has a more calming effect OR has a better track record with severe, endogenous depression. Celexa and Lexapro are both very clean, usually well-tolerated meds that tend to be more "calming" than Prozac. On the other hand, tricyclic antidepressants have a better track record with depression that is severe, endogenous, or "complicated" (agitated depression, psychotic depression, that kind of thing). Doxepin is great for anxiety, and Tofranil is now available as Tofranil-PM...the once-a-day dosing makes things a little easier. Pamelor, Vivactil, and Elavil are also options. As for the antipsychotic...based on my own experiences, I'm kinda iffy about the widespread use of neuroleptics for depression, especially when a benzo is also being used. That said..I think it might be a good idea to switch out the zyprexa for some abilify...when abilify helps with depression, its usually effective anywhere from 2.5mgs to 15mgs, although I personally would be hesitant to go above 10mgs, again based on personal experience (for some reason, jumping from 10 to 15mgs seems to cause a significant increase in EPS and other problems that doesn't happen with changes in dosage at lower levels). Abilify is usually more or less non-drowsy (sometimes it can be activating) and it carries a lower risk of diabetes, weight gain, and other metabolic weirdness than does Zyprexa...it also *seems* to have a better profile in terms of EPS and what not, although this "edge" diminishes as the dosage goes up. Start up anxiety happens a lot with it, though...presumably, the clonazepam would help to dampen this effect, as would using a more "calming" antidepressant. Propranolol can also help. If you need higher-end doses of BZDs, you could always try a switch from Klonopin to something else...Librium is still used a good bit, and Tranxene is a little-used but (I think) very good option, especially when depression is part of the picture. Xanax helps some people with depression...if you're going to need day-long BZD treatment, Xanax XR would be the better option to prevent rebound anxiety between doses. (For this reason, I would not use Ativan, either). Good luck!
poster:med_empowered
thread:533365
URL: http://www.dr-bob.org/babble/20050723/msgs/534092.html