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Dr. Bob is Robert Hsiung, MD,
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Posted by Chris O on August 6, 2008, at 15:41:23
In reply to Re: What is the best SSRI in our opnion? » SLS, posted by tensor on August 6, 2008, at 15:29:27
Mattias:
I have GAD and panic disorder. I took a high dose of Lexapro (40mg/day) for a full year. I got little or no benefit. I don't know why it didn't work for me. It was frustrating. I just kept upping the dose, as my p-doc recommended (10-20-30-40), and after a year...nothing. That's my two cents. I'm on generic fluoxetine now and it's working better for me, but not perfect either.
Chris
Posted by JDx on August 6, 2008, at 16:15:33
In reply to Re: What is the best SSRI in our opnion?, posted by Chris O on August 6, 2008, at 15:06:09
> Prozac and Celexa worked for me in terms of antidepressant effect. Lexapro and Zoloft did not. Just goes to show how different we all are with SSRIs. In terms of sexual side effects, the anorgasmia/decreased libido was there for Prozac and Celexa. It's manageable though. I got no sexual side effects on Lexapro and Zoloft. But then, I got no benefit either. Go figure with these stupid meds.
>
> Chris
I actually doesn't have depression nor anxiety now, because I am taking Amisulpride+5htp...
The reason I will probably need SSRI add-on is because I want to try adding another antipsychotic med (sertindole or risperidone) , and they both nasty drugs that making me depressed and wanting to kill myself...
So I am not sure if I need strong SSRI, only one enough to keep the antipsychotics side effects at bay
Posted by SLS on August 6, 2008, at 16:20:53
In reply to Re: What is the best SSRI in our opnion? » SLS, posted by tensor on August 6, 2008, at 15:29:27
> for panic attacks and constant worries, do you think Lexapro would be better than Zoloft?
Panic attacks and constant worries might indicate a diagnosis of generalized anxiety disorder (GAD). Paxil and Effexor are pretty good for this. However, Paxil might be the worst among the SSRIs in terms of sexual side effects. You may want to ask others about their experience with Paxil.
I don't know how effective Lexapro is for GAD.
- Scott
Posted by SLS on August 6, 2008, at 16:22:50
In reply to Re: What is the best SSRI in our opnion?, posted by JDx on August 6, 2008, at 16:15:33
Have you tried Abilify or Geodon?
- Scott
Posted by JDx on August 6, 2008, at 16:44:35
In reply to Re: What is the best SSRI in our opnion? » JDx, posted by SLS on August 6, 2008, at 16:22:50
> Have you tried Abilify or Geodon?
>
>
> - ScottI wanted to try Abilify but It is not approved in my country yet, and buying it privatly is very expansive as far I found out
About Geodon - I didn't tried it..some of the reasons were because I didn't like its receptor profile and its safty. Geodone is like ssri+snri+antipsychotic all togther...thats in my opnion enhancing the possibility of side-effects..
I think I will try it only after trying other meds.
Posted by SLS on August 6, 2008, at 18:04:51
In reply to Re: What is the best SSRI in our opnion?, posted by JDx on August 6, 2008, at 16:44:35
> > Have you tried Abilify or Geodon?
> >
> >
> > - Scott
>
> I wanted to try Abilify but It is not approved in my country yet, and buying it privatly is very expansive as far I found out
>
> About Geodon - I didn't tried it..some of the reasons were because I didn't like its receptor profile and its safty. Geodone is like ssri+snri+antipsychotic all togther...thats in my opnion enhancing the possibility of side-effects..
> I think I will try it only after trying other meds.A friend of mine added Geodon 80mg to her regime. It is producing a robust antidepressant effect. Regarding side effects, she reports not having any.
It is tempting to try to figure out what these drugs will do in advance of taking them using laboratory observations of their in vitro properties. It would be a shame if you were to skip over a drug that would work based upon a theory. With Geodon, it is important to START at 40mg. Anything less will produce anxiety and agitation. The effective dosage range of Geodon for depression (and negative symproms) is 40-80mg. For psychosis, the dosage is more like 120mg.
Good luck with whatever path you choose.
- Scott
Posted by Bob on August 6, 2008, at 20:44:14
In reply to Re: What is the best SSRI in our opnion? » JDx, posted by SLS on August 6, 2008, at 18:04:51
>
> It is tempting to try to figure out what these drugs will do in advance of taking them using laboratory observations of their in vitro properties. It would be a shame if you were to skip over a drug that would work based upon a theory. With Geodon, it is important to START at 40mg. Anything less will produce anxiety and agitation. The effective dosage range of Geodon for depression (and negative symproms) is 40-80mg. For psychosis, the dosage is more like 120mg.
>
> Good luck with whatever path you choose.
>
>
> - Scott
>It seems almost counterintuitive that an activating med like Geodon would be activating at lower doses than higher. I asked my pdoc about the rumors surrouding Abilify and this phenomen and he claimed there wasn't a lot of evidence supporting it.
What scares me about jumping to a higher dose of something like Geodon or Abilify is how would one ever taper off of the med if it went awry down the line. I'm exquisitely sensitive to Abilify and if I just started taking a high dose and 3 months down the line had to taper off, I think it it would be mighty, mighty scary.
Posted by JohnnyBLinux on August 6, 2008, at 21:43:23
In reply to What is the best SSRI in our opnion?, posted by JDx on August 6, 2008, at 11:50:39
I've tried a few SSRIs, and out of them all, I'd have to say my current AD Lexapro.
Posted by yxibow on August 6, 2008, at 22:56:55
In reply to Re: What is the best SSRI in our opnion? » tensor, posted by SLS on August 6, 2008, at 16:20:53
The best SSRI is the one that works.
That sounds dull, but its true -- certain SSRIs will work for certain people and certain will not.
Lexapro across the board is a good recommendation but not everybody will tolerate it. It is the "cleanest" SSRI. Yet it took 20 days for me to overcome the near vomiting I had on it and I gave up on it.
You have to outweigh the side effects vs. benefits of an SSRI.
Prozac and Luvox, the earliest are still in use and help a lot of people too.
Most SSRIs will brush the 5HT3 mechanism to some extent but the body will get used to it. That's what causes nausea, and is usually noticeable at dose changes
-- Jay
Posted by SLS on August 7, 2008, at 2:03:32
In reply to Re: What is the best SSRI in our opnion? » SLS, posted by Bob on August 6, 2008, at 20:44:14
> >
> > It is tempting to try to figure out what these drugs will do in advance of taking them using laboratory observations of their in vitro properties. It would be a shame if you were to skip over a drug that would work based upon a theory. With Geodon, it is important to START at 40mg. Anything less will produce anxiety and agitation. The effective dosage range of Geodon for depression (and negative symproms) is 40-80mg. For psychosis, the dosage is more like 120mg.
> >
> > Good luck with whatever path you choose.
> >
> >
> > - Scott
> >
>
> It seems almost counterintuitive that an activating med like Geodon would be activating at lower doses than higher. I asked my pdoc about the rumors surrouding Abilify and this phenomen and he claimed there wasn't a lot of evidence supporting it.
>
> What scares me about jumping to a higher dose of something like Geodon or Abilify is how would one ever taper off of the med if it went awry down the line. I'm exquisitely sensitive to Abilify and if I just started taking a high dose and 3 months down the line had to taper off, I think it it would be mighty, mighty scary.
Stevan Stahl:"Here's a very interesting thing about ziprasidone. Have you ever given ziprasidone at 20 mg and had a patient become activated and agitated? If you have, the reason is that the dosing is too low. Because this is such a powerful 5HT2C antagonist, at low doses, that's all it does. It doesn't have any dopamine antagonism, so it's potentially activating -- at least for those people whose genes don't want to have their 5HT2C receptors blocked. Have you ever given a dose of fluoxetine (Prozac) to a patient and had them have an activation? Fluoxetine is the only other drug that has powerful 5HT2C antagonist properties; in fact, fluoxetine has more powerful antagonist properties than reuptake blocking properties. To prevent this, you've got to do a counterintuitive thing, which is to stop using 20 mg, because you're going to make patients "go bonkers." You've got to use probably 60 mg to have enough robust D2 on board so that the patient doesn't get activated. This is an art. Some patients tolerate different doses than others; but the counterintuitive thing is that you raise the dose, you get less activation. If you've had bad experience with this particular drug, that might help you understand how to dose it."
- Scott
Posted by manic666 on August 7, 2008, at 3:54:10
In reply to Re: What is the best SSRI in our opnion?, posted by JDx on August 6, 2008, at 13:21:50
> > well mirtazapine is good if you want to carry on as normal with sex as it dont effect your sex life.BBBBBBut if like me it turns you into a fat blob you wont get any anyway. it may not do the same to you ,but thats the down side for me. manic666
>
> my doctor actually suggested mirtazapine , but when I went to reading about it , I found out that it has antagonistic effect on muscarinic and serotnin receptors, which means it will probably will damage memory and attention pretty seriously..thats somthing I don't want
>
> Didn't it impair your memory?
>well memory, i carnt say after 40 years of meds my memory is shot anyway . but i dont think mirtazapine was a cause.i wasnt on it that long. i tried a experiment. i didnt eat for two days, an still put on weight. so i aborted the med, dont read to many side effects you can have more on an asprin, an most wont effect you anyway.
Posted by Bob on August 7, 2008, at 12:03:12
In reply to Re: What is the best SSRI in our opnion?, posted by SLS on August 7, 2008, at 2:03:32
>
> "Here's a very interesting thing about ziprasidone. Have you ever given ziprasidone at 20 mg and had a patient become activated and agitated? If you have, the reason is that the dosing is too low. Because this is such a powerful 5HT2C antagonist, at low doses, that's all it does. It doesn't have any dopamine antagonism, so it's potentially activating -- at least for those people whose genes don't want to have their 5HT2C receptors blocked. Have you ever given a dose of fluoxetine (Prozac) to a patient and had them have an activation? Fluoxetine is the only other drug that has powerful 5HT2C antagonist properties; in fact, fluoxetine has more powerful antagonist properties than reuptake blocking properties. To prevent this, you've got to do a counterintuitive thing, which is to stop using 20 mg, because you're going to make patients "go bonkers." You've got to use probably 60 mg to have enough robust D2 on board so that the patient doesn't get activated. This is an art. Some patients tolerate different doses than others; but the counterintuitive thing is that you raise the dose, you get less activation. If you've had bad experience with this particular drug, that might help you understand how to dose it."
>
>
> - Scott
So are you saying that this is how both Geodon and Abilify work, or just Geodon.FWIW, prozac did send me through the roof and cause panic eventually (twice).
Posted by Bob on August 7, 2008, at 12:15:08
In reply to Re: What is the best SSRI in our opnion?, posted by SLS on August 7, 2008, at 2:03:32
>
> Stevan Stahl:
>
> "Here's a very interesting thing about ziprasidone. Have you ever given ziprasidone at 20 mg and had a patient become activated and agitated? If you have, the reason is that the dosing is too low. Because this is such a powerful 5HT2C antagonist, at low doses, that's all it does. It doesn't have any dopamine antagonism, so it's potentially activating -- at least for those people whose genes don't want to have their 5HT2C receptors blocked. Have you ever given a dose of fluoxetine (Prozac) to a patient and had them have an activation? Fluoxetine is the only other drug that has powerful 5HT2C antagonist properties; in fact, fluoxetine has more powerful antagonist properties than reuptake blocking properties. To prevent this, you've got to do a counterintuitive thing, which is to stop using 20 mg, because you're going to make patients "go bonkers." You've got to use probably 60 mg to have enough robust D2 on board so that the patient doesn't get activated. This is an art. Some patients tolerate different doses than others; but the counterintuitive thing is that you raise the dose, you get less activation. If you've had bad experience with this particular drug, that might help you understand how to dose it."
>
>
> - ScottInterstingly, I checked your chart of psych meds, and Geodon doesn't list 5HT2c as one of it's characteristics. Is this an oversight?
Posted by SLS on August 7, 2008, at 14:48:38
In reply to Re: What is the best SSRI in our opnion? » SLS, posted by Bob on August 7, 2008, at 12:15:08
>
> >
> > Stevan Stahl:
> >
> > "Here's a very interesting thing about ziprasidone. Have you ever given ziprasidone at 20 mg and had a patient become activated and agitated? If you have, the reason is that the dosing is too low. Because this is such a powerful 5HT2C antagonist, at low doses, that's all it does. It doesn't have any dopamine antagonism, so it's potentially activating -- at least for those people whose genes don't want to have their 5HT2C receptors blocked. Have you ever given a dose of fluoxetine (Prozac) to a patient and had them have an activation? Fluoxetine is the only other drug that has powerful 5HT2C antagonist properties; in fact, fluoxetine has more powerful antagonist properties than reuptake blocking properties. To prevent this, you've got to do a counterintuitive thing, which is to stop using 20 mg, because you're going to make patients "go bonkers." You've got to use probably 60 mg to have enough robust D2 on board so that the patient doesn't get activated. This is an art. Some patients tolerate different doses than others; but the counterintuitive thing is that you raise the dose, you get less activation. If you've had bad experience with this particular drug, that might help you understand how to dose it."
> >
> >
> > - Scott
>
> Interstingly, I checked your chart of psych meds, and Geodon doesn't list 5HT2c as one of it's characteristics. Is this an oversight?It wasn't at the time. :-)
They discover new properties of psychotropics all the time. I guess I ought to add this to the chart. Thanks for pointing that out.
Posted by SLS on August 7, 2008, at 14:50:03
In reply to Re: What is the best SSRI in our opnion? » SLS, posted by Bob on August 7, 2008, at 12:03:12
>
> >
> > "Here's a very interesting thing about ziprasidone. Have you ever given ziprasidone at 20 mg and had a patient become activated and agitated? If you have, the reason is that the dosing is too low. Because this is such a powerful 5HT2C antagonist, at low doses, that's all it does. It doesn't have any dopamine antagonism, so it's potentially activating -- at least for those people whose genes don't want to have their 5HT2C receptors blocked. Have you ever given a dose of fluoxetine (Prozac) to a patient and had them have an activation? Fluoxetine is the only other drug that has powerful 5HT2C antagonist properties; in fact, fluoxetine has more powerful antagonist properties than reuptake blocking properties. To prevent this, you've got to do a counterintuitive thing, which is to stop using 20 mg, because you're going to make patients "go bonkers." You've got to use probably 60 mg to have enough robust D2 on board so that the patient doesn't get activated. This is an art. Some patients tolerate different doses than others; but the counterintuitive thing is that you raise the dose, you get less activation. If you've had bad experience with this particular drug, that might help you understand how to dose it."
> >
> >
> > - Scott
>
>
> So are you saying that this is how both Geodon and Abilify work, or just Geodon.Just Geodon.
> FWIW, prozac did send me through the roof and cause panic eventually (twice).
Ouch.
- Scott
Posted by Bob on August 7, 2008, at 15:24:28
In reply to Re: What is the best SSRI in our opnion? » Bob, posted by SLS on August 7, 2008, at 14:48:38
> >
> > Interstingly, I checked your chart of psych meds, and Geodon doesn't list 5HT2c as one of it's characteristics. Is this an oversight?
>
> It wasn't at the time. :-)
>
> They discover new properties of psychotropics all the time. I guess I ought to add this to the chart. Thanks for pointing that out.
Something tells me they're going to discover some more properties of Abilify.
Posted by Phillipa on August 7, 2008, at 18:22:45
In reply to Re: What is the best SSRI in our opnion?, posted by SLS on August 7, 2008, at 2:03:32
Scott when it first came out my pdoc in Virginia lived there then gave me prozac although wasn't depressed working and all that and just taking a small dose of xanax. Very tiny. I think it was .25 twice a day. Well first day on Prozac wallpapered a foyer that I'd put off for three years. Day two slight anxiety. Third day anxiety so bad it was sheer panic and sat on the counter all day. Flushed the rest down the toilet and never took it again. BTW dose was 20mg. When saw the pdoc he thought it was remarkable the quick response and begged me to take every three days. I said no way. And three days later was back to baseline which was neither depressed or anxious. So what does that mean larger or smaller dose have 10mg tabs here never took out of fear. Love Phillipa
Posted by annabamma on August 7, 2008, at 23:12:57
In reply to Re: What is the best SSRI in our opnion?, posted by yxibow on August 6, 2008, at 22:56:55
Does anyone know if there's much difference btwn Celexa and Lexapro?? For me Celexa was almost the right one-but the horrible memory problems were too severe!!Is Lexapro much different-or-just a matter of more$$$$$$$$$$$$$$for the drug company.Annabamma
Posted by JDx on August 9, 2008, at 8:55:05
In reply to Re: What is the best SSRI in our opnion? » JDx, posted by SLS on August 6, 2008, at 18:04:51
> > > Have you tried Abilify or Geodon?
> > >
> > >
> > > - Scott
> >
> > I wanted to try Abilify but It is not approved in my country yet, and buying it privatly is very expansive as far I found out
> >
> > About Geodon - I didn't tried it..some of the reasons were because I didn't like its receptor profile and its safty. Geodone is like ssri+snri+antipsychotic all togther...thats in my opnion enhancing the possibility of side-effects..
> > I think I will try it only after trying other meds.
>
> A friend of mine added Geodon 80mg to her regime. It is producing a robust antidepressant effect. Regarding side effects, she reports not having any.
>
> It is tempting to try to figure out what these drugs will do in advance of taking them using laboratory observations of their in vitro properties. It would be a shame if you were to skip over a drug that would work based upon a theory. With Geodon, it is important to START at 40mg. Anything less will produce anxiety and agitation. The effective dosage range of Geodon for depression (and negative symproms) is 40-80mg. For psychosis, the dosage is more like 120mg.
>
> Good luck with whatever path you choose.
>
>
> - Scott
>Ok
yesterday I went to my pdoc , and he perscribed me Lexapro and sertindole
I tried to take Lexapro 5 mg and it has intersting effect compare to 5-HTP
It seems to decrease anxiety and OCD that I aperntly had, and it increases my concentration and alertness , though it has negative effect on my libido and ability to have an erection...
Now, When I add risperone to Lexapro I don't have the so negative effects on the mood and I enjoyed its benefits(risperdone alone made me depressed and wanting to kill myself)
I am going to try sertindole "alone", without Lexapro , and see how it feels...I prefer not to stay on ssri's..
Posted by dcruik518 on August 10, 2008, at 11:48:26
In reply to Re: What is the best SSRI in our opnion?, posted by JDx on August 9, 2008, at 8:55:05
Regarding Prozac: it is one of the worst SSRI's in terms of metabolism because they're are a significant number of caucasians who lack the ability to properly metabolize the cyp450 enzyme. Paxil is the other SSRI susceptible to this problem. OFten people who esperience extreme anxiety on low dose Prozac actually have liver problems and are suffering from Serotonin syndrome. In my opinion Zoloft is the most effective SSRI, mainly because it is good for so many different things, but also because also it has has a little known but significant dopamine reuptake inhibition effect, thus preventing the flattening of affect so common with the other SSRI's.
~Dwight
Posted by tensor on August 10, 2008, at 13:31:52
In reply to Re: What is the best SSRI in our opnion?, posted by dcruik518 on August 10, 2008, at 11:48:26
>OFten people who esperience extreme anxiety on low dose Prozac actually have liver problems and are suffering from Serotonin syndrome.
Could you reveal your sources for those statements.
/Mattias
Posted by SLS on August 10, 2008, at 15:44:11
In reply to Re: What is the best SSRI in our opnion?, posted by dcruik518 on August 10, 2008, at 11:48:26
> Regarding Prozac: it is one of the worst SSRI's in terms of metabolism because they're are a significant number of caucasians who lack the ability to properly metabolize the cyp450 enzyme. Paxil is the other SSRI susceptible to this problem. OFten people who esperience extreme anxiety on low dose Prozac actually have liver problems and are suffering from Serotonin syndrome. In my opinion Zoloft is the most effective SSRI, mainly because it is good for so many different things, but also because also it has has a little known but significant dopamine reuptake inhibition effect, thus preventing the flattening of affect so common with the other SSRI's.
>
> ~Dwight
Also: Prozac is a more potent 5-HT2c antagonist than it is a reuptake inhibitor. At lower dosages, the 5-HT2c receptor antagonism prevails, and produces activation and agitation. This often disappears at higher dosages. Steven Stahl describes this in a Medscape article, but doesn't specify what he considers to be a low dosage. This same phenomenon is seen with Geodon. For both drugs, it is recommended to begin at the therapeutic target dose, i.e. 20mg for Prozac and 40mg for Geodon.
- Scott
Posted by dcruik518 on August 10, 2008, at 18:40:09
In reply to Re: What is the best SSRI in our opnion? » dcruik518, posted by tensor on August 10, 2008, at 13:31:52
Well my first source was my psychiatrist who thought that might be the reason why I found prozac so overstimulating. Here's an article, though, that gets into it fairly well. I have to admit, though, I don't understand the science very well. This author describes it as a genetic variation in the speed in which people are able to metabolize these drugs, rather than a defect.
> >OFten people who esperience extreme anxiety on low dose Prozac actually have liver problems and are suffering from Serotonin syndrome.http://www.psychotropical.com/index.shtml
>
> Could you reveal your sources for those statements.
>
> /Mattias
Posted by BearFan on August 11, 2008, at 23:26:09
In reply to What is the best SSRI in our opnion?, posted by JDx on August 6, 2008, at 11:50:39
Doctors usually prescribing Lexapro or Celexa first, although you may get a better response with another one.
Posted by mikez on August 12, 2008, at 1:57:31
In reply to Re: What is the best SSRI in our opnion? » SLS, posted by Phillipa on August 6, 2008, at 14:04:26
I would try Luvox, its the only SSRI shown not to decrease sex drive. I found it very effective however it caused severe insomnia for me so I had to stop...but that is not a common side effect and it is sleep promoting for plenty of people.
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