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Dr. Bob is Robert Hsiung, MD,
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Posted by Cousin Eddie on January 7, 2001, at 22:47:34
In reply to Re: Celexa--Dawn, posted by Shelley in Seattle on March 2, 1999, at 12:56:55
I took 20 mg. Celexa per day for six weeks, then 40 mg. for two months. It didn't perform any magic on its own, although it did take the edge off my depression. Only when combined with a short half-life tranquilizer (Clonazepam), Adderall, and especially Wellbutrin did I feel much better. I'm a 32 year old guy, and I weigh about 180 lbs.
I've taken dry mouth in the morning for granted (very small price to pay), but sexually there has been some frustration. Sex with my wife is regular (3 or 4 times a week), erection not a problem, but finishing up happens only once per month. My wife loves it of course, and again, it is a small price to pay for not being suicidally depressed.
I really recommend Celexa, and you have to be patient (two months at the very least).
Posted by claire on January 8, 2001, at 14:54:02
In reply to Re: Celexa side-effects/weight gain, posted by Jessi on May 26, 1999, at 16:14:11
Just something to consider--for those who had been taking other SSRIs before Celexa, the side effects for all are different--many people lose weight on Zoloft, gain on Prozac, etc--a weight gain after switching to Celexa may simply be a rebound effect from weight loss (even sustained) that was experienced on another SSRI [at least to some degree]. I know this may not be of great help, but at least in balancing the pros and cons--I'd rather be heavier and happier than thin and miserable. I guess it may all be about perspective and if Celexa helps you find a better persepctive THAT is the most importance side effect (well, one of them!)--good luck to everyone!
Posted by Dione on January 10, 2001, at 22:04:55
In reply to Re: Celexa side-effects/weight gain, posted by gail on June 24, 1999, at 8:28:35
I have been on Celexa for about 3 months. I love the way it has even my temperment and reduced my anxiety and depression, however I am not pleased with the amount of weight I have gained as result of this durg. My desire for food has not increased or changed and my eating patterns are the same as pre-medication-but I have gained at least 10 to 15lbs. that I can not seem to get ride of-no amount of diet or exercise has seemed to help-please someone advise I'm desperate-I have recently started taking Metabolife to help in my quest to loose this weight, but I was told that I should proablly not mix the two-What's a girl to do?
Posted by LIZAJANE on January 26, 2001, at 8:55:15
In reply to Re: Celexa side-effects/weight gain, posted by Dione on January 10, 2001, at 22:04:55
> I have been on Celexa for about 3 months. I love the way it has even my temperment and reduced my anxiety and depression, however I am not pleased with the amount of weight I have gained as result of this durg. My desire for food has not increased or changed and my eating patterns are the same as pre-medication-but I have gained at least 10 to 15lbs. that I can not seem to get ride of-no amount of diet or exercise has seemed to help-please someone advise I'm desperate-I have recently started taking Metabolife to help in my quest to loose this weight, but I was told that I should proablly not mix the two-What's a girl to do?
I have been on Celexa for 1 month (10mgs)and have actually lost 8 pounds...
The first 3 weeks were agony... I had the worst anxiety
and insomnia... I found that I can not drink more than 2 glasses of
wine with Celexa or get insomnia and generally
do not feel as well... I think that added to the
weight loss... for years I self medicated with caffeine
in the morning (great for the mood, but bad for the
anxiety and agoraphobia), and wine at night...With Celexa I have cut out
the caffeine all together (get the up that I use to get
without the anxiety) and do not drink more than 2 glasses
of wine with dinner... The only problem is
some insomnia now and then... has anyone tried taking
Tylenol PM for that??? Also I tried to up my dose
to 15mgs last week and had such severe anxiety off and
on for 24 hours that I went back down to 10mgs... anyone
out there done well on 10mgs... I feel good, minor
anxiety but CALM... I LOVE that calmness... that is what made me
stick out the side effects in the first place...
Any thoughts on the above comments would be appreciated
now
Posted by Michael39 on February 19, 2001, at 19:55:59
In reply to Re: Celexa --Dawn, posted by Ala on March 9, 1999, at 11:49:29
After 3 months of Celexa, I am extremely satisified with the results!(As is my wife!..What a change!) Several years ago when I was dianosed with dysthimia and mild manic episodes, I was given desepramine after a consulation with a psychiatrist and psychologist. Desepramine, to say the least was a disaster! Not only were the night sweats unbearable, but the constipation nearly drove me mad. At my follow up, I told the doctor about this side effect and explained that I was already "anal retentive" enough and did't need any more help! For several years I've struggled wtih mood swings, depression, anxiety and bouts of anger. Celexa has been like a new day's sunrise for me! I don't know how to express my tremendous satisfaction with this SSRI. Feel free to write me with your questions should you read this posting.
Posted by Alli on February 19, 2001, at 20:12:12
In reply to Re: Celexa , posted by Michael39 on February 19, 2001, at 19:55:59
What is your doseage, and have you experienced any weight gain? Alli
Posted by pvs321 on February 21, 2001, at 22:29:21
In reply to Re: Celexa , posted by Alli on February 19, 2001, at 20:12:12
I have been taking Celexa for about 4 weeks, after one year of Zoloft, which was the first AD i have ever tried. I felt great for several months on the Z, but it seemed to be losing its benefits, thus the Celexa (20 mg/day).
I feel terrible. I feel anxious, i sleep during lunch and go to bed earlier and earlier. I feel anxious, somewhat confused and more withdrawn of late. I read all of the good results people get with Celexa, how long does it usually take to become effective?
What is your doseage, and have you experienced any weight gain? Alli
Posted by Cousin Eddie on February 21, 2001, at 23:47:01
In reply to Re: Celexa , posted by pvs321 on February 21, 2001, at 22:29:21
Hi Alli. I have been in your boat. The two weeks after I began taking Celexa exclusively, after a few months of 150 mg. Zoloft/day, were the worst time in my therapy-SSRI withdrawal was the scariest period of my life, even worse than Lariam prophylaxis. After the two weeks (taking 20 mg. Celexa/day)I began to feel human again. The side effects definitely persisted: the hot flashes, sweating, diarrhea, sleepiness, then insomnia all lasted a good six weeks after starting Celexa. My doc ramped me up pretty quick to 30 mg. (for a week), then to 40 mg., which I'm now taking. So, to answer your question, it will take about a month or two from the end of the transition to another SSRI to feel noticeably better, in a consistent way. I saved this article from last year because it enlightened me as to elementary brain chemistry-like psych meds for dummies, as well as the importance of sticking with a prescribed pill regimen. Please excuse my posting this copyrighted article, I couldn't provide a weblink without paying through the nose to the Wash. Post.
--------------------------------------------------The Washington Post, June 20, 2000
June 20, 2000, Tuesday, Final EditionHEADLINE: Making the Three Tenors Sing; In Successful Depression Treatment, the
Brain's Three Neurotransmitters Must 'Harmonize.' Sometimes, a Leading Psychiatrist Says,
More Than One Medication May Be Necessary
BYLINE: Alen J. Salerian , Special to The Washington Post
BODY:
During my first session with Sarah, a married, 40-year-old lawyer, she complained about
frustrating failures she had experienced in treatment of her depression.
"After all this therapy and all these medications, I still don't feel like getting out of bed in
the morning," she said. She leaned forward and gently placed a piece of paper on my desk.
It was a printout of all the medications she had taken during the past two years: Zoloft at
200 mg for six months. Prozac at 60 mg for three months. Sixty mg of Paxil for six months,
then 400 mg of Wellbutrin for three months. Serzone at 600 mg for two months. Finally,
1,500 mg of lithium for two months.
There were two- or three-week breaks between medications. She had seen several doctors.
Her frustration was understandable.
But her worry changed to surprise when I suggested that, instead of continuing to try
different drugs in sequence, she pursue a "combination strategy"--taking more than one of
these drugs at a time.
A combination strategy was something I'd been sharing with medical students and patients
for years. It arises from understanding the role of what I call "the three tenors," the three
key neurotransmitters in the brain that regulate mood--serotonin, dopamine and
norepinephrine. As an opera lover, I like to see them as voices singing in the mind. When
they sing in harmony and balance, they can make a person feel comfortable in life. But
when one of the tenors is out of sync, the music can be disturbing, even frightening.
It may be ordinary knowledge for a psychiatrist to appreciate how each neurotransmitter
works--that serotonin regulates worry and anger, that dopamine is critical for initiative and
pleasure and that norepinephrine controls alertness and energy. But this information is
rarely shared with those being treated. It should be, because it is often the foundation for a
successful treatment, one that manages to work even after many others have failed.A little history is helpful. From the days when the first antidepressant, iproniazid, was
serendipitously discovered in the 1950s, many advances have occurred in the treatment of
depression. Yet the central biological challenge has remained the same: how to make one,
two or all three tenors sing in harmony.
The first group of antidepressants, called tricyclics and monoamine oxidase inhibitors,
were an effective but unfriendly bunch. They indeed helped all three tenors sing vibrantly,
but they produced very unpleasant noises along the way. To reach their effective levels, one
had to suffer horrible side effects. For example, the trycyclic antidepressant Elavil caused
such intense drowsiness that many patients reported feeling like zombies. Other
medications caused dry mouth, constipation, sedation and other less severe problems.
The introduction in 1988 of Prozac, the first drug of a class called selective serotonin
reuptake inhibitors, or SSRIS, marked a significant breakthrough in treatment. It was based
on the discovery that elevating serotonin levels was crucial in alleviating depression. Prozac
was the first "designer" antidepressant, which selectively targeted serotonin alone.
Consequently it produced significantly fewer and less severe side effects than its
predecessors.
Thanks to the subsequent development of the many similarly targeted SSRIS, by the late
1990s American psychiatrists had at least 20 antidepressants to choose from to treat
depression. Most psychiatrists quickly learned that Prozac and Paxil would increase
serotonin but would not alter norepinephrine or dopamine, whereas Wellbutrin would
elevate brain dopamine concentrations without much effect on serotonin. And Effexor would
increase both norepinephrine and serotonin. Regardless of the mechanism or action, all
were considered similarly efficacious--which is to say sometimes they worked and
sometimes they didn't.
Gradually among American psychiatrists, a simple protocol was adopted to treat cases of
depression: Choose an antidepressant that treated one lead tenor. If that didn't work, try
another. And keep trying different ones until the desired effect was achieved. Yet most
researchers agreed that even with the best combination of psychotherapy and the most
effective single medication, still roughly 30 percent of individuals with depression would not
improve.
Luckily for patients like Sarah, in the last several years many quiet discoveries have been
made in the clinical practice of psychiatry. First, it was discovered that not all
antidepressants are effective for severe depressions. Also, that antidepressants with
dual action--those that influenced two tenors, like serotonin and norepinephrine--often
performed better than the antidepressants that target a solo tenor. And further, that
combining antidepressants often worked better than using a single one.
Sarah's case illustrates the point.
I asked Sarah to tell me more about her depression. "What troubles you most?"
"Worry," she responded. "I keep thinking I'm going to miss something important. That I'm
going to hurt somebody. In reality I know I do a good job as a criminal attorney, yet I'm
afraid I'm going to screw up. I know there's no basis for it, but the fear of hurting one of my
clients paralyzes me. There are days when I can't even leave home because of it."
Sarah stared into her lap, then looked up at me. "So what can you do for me?"
"What I can do for you is put you on Paxil and Wellbutrin."
"I've tried both and neither worked," she said. "Not to mention that Paxil made me sleepy
and edgy."
"Your medication history indicates that you never took these medications in combination.
And there is good evidence that what we call 'augmentation therapy' works better."
She was skeptical. She said this sounded very "aggressive," and wondered whether she was
my "guinea pig" in an experiment.
Six weeks later, after trying the regimen, Sarah had fully recovered.
"I cannot tell you how good and worry-free I feel," she said. "It's like a burden has been
lifted." But recovery had not been an easy ride--or without a change in course.
Extreme fatigue and nausea troubled her, yet once she had decided to try the combination
therapy, she wasn't going to stop her medical trial. By the end of the fourth week--a
reasonable point to evaluate the overall response to treatment--Sarah had reported being
"60 percent better" but said she still lacked energy and zip.
I recommended she add Adderall--an amphetamine-like medication often used to treat
attention deficit disorder--to further boost her dopamine.
And finally, Sarah's tenors began to sing, thanks to a combination of Wellbutrin, Paxil and
Adderall.
Sarah is not an exception. I've treated hundreds of patients who have responded well to
combination strategies.
Recent research is also promising for the use of various hormones--such as testosterone,
estrogen, DHEA and thyroid hormones--to augment the efficacy of various
antidepressants. Again, augmentation therapy appears to be a novel way to stimulate a
pleasant mood.
A few things about treating depression are clear. Poor response to treatment should always
be a reason to search for a new strategy. And it is critical to educate patients about the
chemistry of mood and how serotonin, norepinephrine and dopamine affect the way the
brain responds to life. Just as the three tenors sing best when they work together, the three
neurotransmitters make the best mood music for the brain when they're balanced
harmoniously.
Which is largely why I believe that most depressions are curable--and that most patients
are able, eventually, to hear the music.
Alen 3. Salerian, MD, is medical director of the Washington Psychiatric Center outpatient
facility for the Psychiatric Institute of Washington. He has just completed a novel, "Red
Zone," about abuses in psychiatric managed care.< end article >
-------------------------------------------------Please see my previous post six posts above yours to see what I'm taking. I feel SO MUCH better since I went off Zoloft four months ago (I am not dissing the drug). Please take comfort in the power of these meds, and in the strong possibility that your moods at present are chemically induced. My doc always said Give It Time, and with a pretty exotic mix of meds waiting has paid off.
I pray that a disciplined course of treatment pays off for you as well.
-Steve-
Posted by gladys on February 23, 2001, at 10:26:21
In reply to Re: Celexa » pvs321, posted by Cousin Eddie on February 21, 2001, at 23:47:01
I am so interested in asking my doctor about adding other drugs because although at first the celexa was great, it seems to have stopped working although it was raised again. i am up to 50 mg and moving to 60. but i feel that the article about going on different meds with it is a great idea. my only problem is, this is a little embarrassing, my doctor is intimidating. she can be kind of pompous and act as though i know nothing so i don't know if she will even consider it and am actually nervous to bring it up. does anyone else know what this is like? any suggestions? i can't change doctors right now, i just don't have the energy and would probably not follow through which means no meds and that is worse. any ideas from anyone here would be great. thanks.
Posted by Cousin Eddie on February 23, 2001, at 10:56:47
In reply to Re: Celexa , posted by gladys on February 23, 2001, at 10:26:21
I showed that article to my doc, he said yeah, he had considered doing something like that for me, but had decided it wasn't for me. And he is very open to suggestion, not pompous in the least. Three weeks later, after digesting the article or maybe talking with the author (both practice @ DC), whatever, we gave it a try. It worked where Celexa alone didn't. Scoring high on some of< a href="http://psychcentral.com/quizzes.htm" >these tests< /a > had something to do with it too.
Posted by pvs321 on February 25, 2001, at 21:02:04
In reply to Re: Celexa , posted by Alli on February 19, 2001, at 20:12:12
> What is your doseage, and have you experienced any weight gain? Alli
I have been taking 20mg/day, but felt so weird I upped it to 30. I am gaining weight, which is unusual for me. I can't get enough sweets lately, which is also unusual for me. Paul
Posted by Nora on February 27, 2001, at 15:44:36
In reply to Re: Celexa, posted by Pat on March 6, 1999, at 13:17:12
I took Zoloft for at least 5 years. It was good for my mood but I lost all sexual feelings. Since I was feeling good, I tried to go cold turkey a couple of months ago. I crashed and burned at the end of January with terrible anxiety. The doctor put me on Celexa and Xanax (short term) for the anxiety. I feel better now, the anxiety is gone, but the Celexa made me terribly constipated and gave me a dry mouth and my sexual feelings are gone again. Maybe I should have given it a longer period but I've decided to go back to Zoloft.
Zoloft also, probably, caused me to gain a lot of weight. The doctor said Celexa should not do that.
Do you think I should have stuck it out longer with Celexa? I was becoming obcessed with being constipated. My kitchen is full of bran, prunes, prune juice, etc., etc. Ridiculous.
Posted by connie on March 1, 2001, at 15:15:40
In reply to Re: Celexa , posted by pvs321 on February 21, 2001, at 22:29:21
OK, i had taken paxil for 6 months (started at 20....bumped up 10 mgs. every couple of months) and now my dr. has me on celexa. started taking 20 mgs in october, bumped up to 30, now up to 40. i feel awful!!! i cry 60% of the time. i am no better off today than i was a year ago. i have ZERO energy. i try to hide my fatigue from my children so that it doesn't upset them that mommy is always tired.
i have an appointment with a new diagnostic doctor next week and i'm praying that he'll switch me to something that will work.
i've recently read that taking low doses of ritalin every morning can eliminate some of the fatigue. any thoughts on that?
thanks,
connie
Posted by gladys on March 2, 2001, at 10:35:09
In reply to Re: Celexa , posted by connie on March 1, 2001, at 15:15:40
Connie,
that's awful. well as you probably hear a lot some meds work for some people and some just don't. paxil made me so depressed although the doctor said that it was impossible. but once i went off of it i was so much better. maybe you need something else or need to take something else with the celexa. definitely tell your doctor everything. write anytime if you like. good luck, gladys
Posted by Nora on March 2, 2001, at 12:10:03
In reply to Re: Celexa , posted by connie on March 1, 2001, at 15:15:40
> OK, i had taken paxil for 6 months (started at 20....bumped up 10 mgs. every couple of months) and now my dr. has me on celexa. started taking 20 mgs in october, bumped up to 30, now up to 40. i feel awful!!! i cry 60% of the time. i am no better off today than i was a year ago. i have ZERO energy. i try to hide my fatigue from my children so that it doesn't upset them that mommy is always tired.
>
> i have an appointment with a new diagnostic doctor next week and i'm praying that he'll switch me to something that will work.
>
> i've recently read that taking low doses of ritalin every morning can eliminate some of the fatigue. any thoughts on that?
>
> thanks,
> connieYou definitely need to see a different doctor. Someone who really cares about you can make all the difference in the world. Good luck to you.
Posted by gladys on March 4, 2001, at 10:58:58
In reply to Re: Sick and tired of being so tired!!!! » gladys , posted by tdaneen on September 23, 2000, at 10:44:23
Hello,
I was wondering about the 60 mg of celexa. do you need to take two different pills? i heard that they only make 40 mg, so i was paying the same price for 40 mg bottle and then a 20 mg bottle and could not afford it so i am back down to 40 mg now. do you have to pay for two precriptions too, or is there a 60? i am pretty discouraged! they're SO expensive! thanks, gladys
Posted by Nora on March 5, 2001, at 9:20:17
In reply to Re: Sick and tired of being so tired!!!! , posted by gladys on March 4, 2001, at 10:58:58
> Hello,
> I was wondering about the 60 mg of celexa. do you need to take two different pills? i heard that they only make 40 mg, so i was paying the same price for 40 mg bottle and then a 20 mg bottle and could not afford it so i am back down to 40 mg now. do you have to pay for two precriptions too, or is there a 60? i am pretty discouraged! they're SO expensive! thanks, gladysYour doctor should write the prescription so that you get enough 40 mg tablets that you can take 1-1/2 a day (60 tablets a month). You shouldn't have to buy two sizes. The tablets are scored so they are easy to divide.
Posted by cc on March 7, 2001, at 15:00:38
In reply to Re: Celexa in pregnancy, posted by lindsey on June 22, 1999, at 15:42:51
was wondering if anyone had information regarding CELEXA & PREGNANCY?
i only found limited material and so far the information is not helpful.
thanks in advance.
cc
Posted by Renee on March 16, 2001, at 15:35:03
In reply to Re: Celexa side-effects/weight gain, posted by Mary on June 9, 1999, at 17:30:05
> I have been on Celexa 10 mg to 20 mg bump up and I experienced hot flashes, chills, joint pain, restlessness, extreme agitation, moodiness, change of taste, headaches, tremors, fatigue and just all around feeling of detachment. I also suffered from extreme cold hands and feet. My doctor said he had never heard of these side effects before with Celexa, have any of you?
Posted by Cousin Eddie on March 16, 2001, at 16:29:46
In reply to Re: Celexa side-effects, posted by Renee on March 16, 2001, at 15:35:03
To Renee-
For the first month taking 10, then 20 mg. Celexa as my only med, I shared your side effects of (in order of extremity) hot flashes, profuse sweating, heightened social anxiety, uncontrollable trembling in my hands, and seldomly headaches; never any weight gain or loss attributable to Celexa. After several months of Celexa and other meds the only side effects I can now confidently still attribute to Celexa are trembling hands, profuse sweating, and diarrhea, all of which I can easily live with.
Posted by KARAsweet on March 19, 2001, at 13:45:56
In reply to Celexa dosage increase, posted by Sean on June 7, 1999, at 9:39:08
when my dosage was upped from 20 to 40 mg I experienced the opposite of what the whole point is of taking it.. I was ultra moody for 2 weeks, but after that I felt 100% better. It takes time to adjust and let it into your system, but in the meantime it's hard to be patient when your moods are fluctuating.
Posted by nat on March 20, 2001, at 12:11:18
In reply to Re: Celexa dosage increase, posted by KARAsweet on March 19, 2001, at 13:45:56
hi everybody, here it is for me:
prozac: -cleared my mind
-didn't help with social anxiety
paxil: -very little relief of depression
-big constipation problem
-lowered sex drive
wellbutrin
+ celexa:i'll update when i see any changei'm 26, female, 120 pounds,5'3 weight never dramatically affected by any medication, i eat right, exercise and all. My blood type is A+
....i'm hesitating on trying hormones like DHEA and stopping all meds...not sure anybody tried that? i have some blood tests done, it's all normal...
Posted by gladys on March 20, 2001, at 14:45:15
In reply to Re: Celexa » gladys, posted by Cousin Eddie on February 23, 2001, at 10:56:47
Hi Cousin Eddie,
Well, I changed doctors now and asked my new doctor what she thought about the article. I was feeling hopeful. She said instead of starting to add anything new she has upped my celexa to 60 mg and my buspar to 60 mg both daily. she said if this doesn't work she would rather try prozac than try others with celexa. I am worried though because I have heard such horror stories about prozac, and when i was on paxil I was nearly suicidal and trying prozac makes me worry i may feel like that again. so i am hoping the celexa will work. I would rather stay on the celexa and add other things if needed as the article suggests! I'm so frustrated.
Posted by amycel on March 22, 2001, at 9:17:27
In reply to Re: Celexa , posted by gladys on March 20, 2001, at 14:45:15
For two years I have been on Celexa(40mg). I decided it is time ot get of this drug.
Last couple of months I have beed decreasing my dosage to 30mg. That went great.
Now I'm on 20mg and I'm feeling so tired. I have been on 20mg for nearly two weeks now.
I can hardly work. I could sleep all day. Is this natural will it go away? The doctor wants me to eventually get on 10mg and so on. I'm not sure I can handly this much longerAmyCel,
Posted by Bill L on March 25, 2001, at 20:01:46
In reply to Getting Off Celexa - So Tired, posted by amycel on March 22, 2001, at 9:17:27
Were you feeling well on Celexa? Did you have bad side efects? If you have been doing good on Celexa, maybe you should go back to 30 and stay on that indefinitely. Otherwise, if for some other reason you feel like you need to wean off of it, you can get the liquid and more gradually reduce the dosage.
> For two years I have been on Celexa(40mg). I decided it is time ot get of this drug.
>
> Last couple of months I have beed decreasing my dosage to 30mg. That went great.
> Now I'm on 20mg and I'm feeling so tired. I have been on 20mg for nearly two weeks now.
> I can hardly work. I could sleep all day. Is this natural will it go away? The doctor wants me to eventually get on 10mg and so on. I'm not sure I can handly this much longer
>
> AmyCel,
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Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
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