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Dr. Bob is Robert Hsiung, MD,
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Posted by michelle41a on October 15, 2010, at 12:37:01
In reply to Re: zoloft dosage increase issues again :( » michelle41a, posted by morgan miller on October 12, 2010, at 10:40:14
> Have your doctor tell the insurance company you are experiencing bad side effects with the generic and you NEED brand as you did not have problems with it in the past. Ever time I had my doc do this it was approved and my insurance company started covering the brand. Do you have decent insurance? You really should talk to your doctor and push to get your insurance to cover the brand. When I tried generic sertraline my stomach was messed up for a month so I went back to Zoloft. This is your physical and mental health, it's not worth messing around with a crappy generic version of a great drug.
Hi Morgan!
If I can't get the brand name zoloft, is there a more effective generic other than camber pharmacy that I can take?
Thanks again!
Michelle
Posted by morgan miller on October 15, 2010, at 15:21:54
In reply to Re: zoloft dosage increase issues again :(, posted by michelle41a on October 15, 2010, at 12:37:01
Hmm, I really don't know if there is a superior generic out there. You may want to make a new post/thread asking this question. I know people have ideas what may be better Prozac generics, but I'm not sure about Zoloft.
I really think if you fight for it enough and get your doctor involved, the insurance company will pay for most of it. Unless, your insurance company is really about accommodating their customers.
How have you been feeling?
Morgan
Posted by michelle41a on October 15, 2010, at 16:53:41
In reply to Re: zoloft dosage increase issues again :( » michelle41a, posted by morgan miller on October 15, 2010, at 15:21:54
> Hmm, I really don't know if there is a superior generic out there. You may want to make a new post/thread asking this question. I know people have ideas what may be better Prozac generics, but I'm not sure about Zoloft.
>
> I really think if you fight for it enough and get your doctor involved, the insurance company will pay for most of it. Unless, your insurance company is really about accommodating their customers.
>
> How have you been feeling?
>
> MorganHi Morgan!
I will create a new post about the generic Zoloft today.. I have Blue Care Network so they try to push generic on their customers :( But if I can't get a generic version that works as good as brand, I am going to push them to let me get brand name.
I did raise the dose to 18.75 on Oct 3rd. From oct 3rd - 9th my brain felt like mush and I had TMJ pain. My mind started to clear on the 10th, but by the 13th, I started to become nauseated more often.. So on the 13th, I dropped the dose by 3.125 (I split the 12.5 in half, then split the 6.25 in half) I took the 15.625 dose for 2 days, then went down to 12.5 Unrortunately, the day after the 12.5 dose, I had extreme panic and sweating upon waking..My abdomonal cramping came back as well. So, I bumped the dose back up to 15.625 dose yesterday. This morning, the panic and sweating was there, but not as bad as yesterday..
I am starting to take .25 klonopin when I wake up now to help with the morning anxiety. The klonopin is really working well for the panic..I do believe the Zoloft has helped but the side effects are annoying :(
To be honest, I can't believe that I am so sensitive to dosage changes when I am well below the "normal theraputic dose" My therapist thinks it is due to my high metabolism, hormonal imbalance (premature menopause) and the bad reaction I had to Prozac. Maybe Zoloft is just too stimulating,like the prozac was.. Ahhh the frustration of it all LOL!
Sorry for the long winded post lol! I have been on zoloft for almost 6 weeks now, but I guess I should give it another couple weeks before I go to lexapro.. I just want the abdominal cramping to stop and have a decent appetite again..
Michelle
Posted by morgan miller on October 15, 2010, at 17:12:34
In reply to Re: zoloft dosage increase issues again :(, posted by michelle41a on October 15, 2010, at 16:53:41
If you get brand Zoloft, I would give it 4 to 6 more weeks.
Lexapro is a great drug. It is possible your insurance might insist on you taking Celexa instead, I hope this isn't the case.
Sorry you are so sensitive to drugs, that definitely sucks, especially if the change in sensitivity came about in part because of Prozac.
I would look at Klonopin as a temporary treatment if I were you. For several reasons, mostly because it can become increasingly mind numbing(it was for me), klonopin is best to use periodically as needed or for a short period everyday.
What you want is to be on one drug, in your case either Zoloft or Lexapro, and for that one drug to treat your anxiety up to 50 or 70 percent. Then, you need to do other things like exercise, yoga, and meditation to try to treat the remaining 30 or 40 percent. You can also try more natural treatments/supplements to help treat some of your anxiety.
Personally, I would try to stay as low as .25 mg klonopin. This will make it much easier to get off of when you choose to do so.
Morgan
Posted by michelle41a on October 16, 2010, at 19:15:54
In reply to Re: zoloft dosage increase issues again :(, posted by morgan miller on October 15, 2010, at 17:12:34
Hi again!
As some of you know, I bumped up my zoloft dose on Oct 3rd from 12.5 to 18.75..
For the past two days, I have been having some serious anxiety issues.. I forgot to mention that I switched from mylan klonopin to teva klonopin on Oct 5th.. Ever since I switched klonopin generic brands, the anxiety has been worse.
I wake up with sweating, heart pounding ,nausea, loss of appetite and general weirdness has increased..
Could it be possible my increased anxiety is from switching generic klonopin brands?? I can't imagine that a small dosage increase of zoloft would cause this much anxiety!
I was thinking of going back to mylan klonopin to see if it helps.. Any info/suggestions would be greatly appreciated!!
((HUGS))
Michelle
Posted by Phillipa on October 16, 2010, at 22:32:50
In reply to Possible issues with klonopin brand switch :(, posted by michelle41a on October 16, 2010, at 19:15:54
I feel an excellent idea then you will know for sure. Please let me know how it goes? Phillipa
Posted by michelle41a on October 16, 2010, at 23:32:03
In reply to Re: Possible issues with klonopin brand switch :( » michelle41a, posted by Phillipa on October 16, 2010, at 22:32:50
> I feel an excellent idea then you will know for sure. Please let me know how it goes? Phillipa
I will definitely let you know, Phillipa :)
I appreciate your input and support!
I am also wondering if my premature menopause and ovarian cyst is interfering with the meds.. I am going to ask the doc about going on birth control to calm down the hormones.. I didn't think that turning 41 was going to be this darn frustrating!!
Posted by morgan miller on October 17, 2010, at 11:31:45
In reply to Re: Possible issues with klonopin brand switch :(, posted by michelle41a on October 16, 2010, at 23:32:03
That sucks you are experiencing issues with switching clonazepam generics. I'm wondering if sertraline is more the cause of your symptoms, and less the switch with clonazepam.
Hopefully your doctor can contact your insurance company and talk them into approving coverage for brand Zoloft. I'm really interested to see if it makes a difference.
In a month or two, if things are not improving with Zoloft, it might not be a bad idea to consider Lexapro.
Hope your feeling better today.
Morgan
Posted by Phillipa on October 17, 2010, at 19:18:46
In reply to Re: Possible issues with klonopin brand switch :(, posted by michelle41a on October 16, 2010, at 23:32:03
All I know is that menopause caused me to be very anxious. Phillipa
Posted by michelle41a on October 17, 2010, at 22:52:31
In reply to Re: Possible issues with klonopin brand switch :(, posted by morgan miller on October 17, 2010, at 11:31:45
> That sucks you are experiencing issues with switching clonazepam generics. I'm wondering if sertraline is more the cause of your symptoms, and less the switch with clonazepam.
>
> Hopefully your doctor can contact your insurance company and talk them into approving coverage for brand Zoloft. I'm really interested to see if it makes a difference.
>
> In a month or two, if things are not improving with Zoloft, it might not be a bad idea to consider Lexapro.
>
> Hope your feeling better today.
>
> MorganHi Morgan!
I am calling my Pdoc tomorrow to see if he can help me get the brand name zoloft.. I am sure the generic zoloft is causing some of my issues..
I did find a pharmacy that has mylan klonopin so I will be going there today to pick it up..
I am going to post a thread about benzo tolerance..Hopefully I don't need to take more klonopin! I am at .5mg a day..I would like to stay there..
Unfortunately, I had a really rough night. I was basically in the fetal position most of the night and maybe slept 4 hours total.. My appetite the past 2-3 days is horrible again.. I am so hungry but I have to force myself to eat..
I have that sinking feeling that the Zoloft is becoming too stimulating like the prozac.. I took 15.625 tonight and I am feeling wired up.. I don't feel as bad as I did last night..
The abdominal pain is not as frequent so hopefully I can get a decent night's sleep.. I wonder if I can just wean off the zoloft without having withdrawals.. I was on ssri's for so long, I am afraid that my body needs it now in some form.. I guess lexapro will be next..I just hope it doesn't have the harsh side effects that Zoloft has..
Michelle
Posted by michelle41a on October 17, 2010, at 22:54:52
In reply to Re: Possible issues with klonopin brand switch :( » michelle41a, posted by Phillipa on October 17, 2010, at 19:18:46
> All I know is that menopause caused me to be very anxious. Phillipa
I also have a cyst on my left ovary the size of a ping pong ball.. My friend has a cyst as well.. She is going on birth control to shrink it.. I wonder if I can try birth control as well.. Might even out my hormones :)
Michelle
Posted by michelle41a on October 17, 2010, at 22:59:46
In reply to Re: Possible issues with klonopin brand switch :(, posted by morgan miller on October 17, 2010, at 11:31:45
What amazes me is that I can have such crazy side effects from such a small dose of zoloft.. I guess with my hormones being out of whack, it might be making my body chemistry sensitive to ssri's..
Do you think dropping the dosage from 18.75 to 15.625 is too much? I was on the 18.75 for 10 days.. I would love to just take the 25mg but I am afraid it will make me worse off than I am now..
Posted by morgan miller on October 18, 2010, at 19:21:53
In reply to Re: Possible issues with klonopin brand switch :( » morgan miller, posted by michelle41a on October 17, 2010, at 22:59:46
I know you are trying to avoid the anxiety Zoloft gives you during the day when you take it in the morning, but I still wonder what things would be like for you if you tried a first thing in the morning dose for a week? Do you really want agitation and anxiety at night when you are supposed to be calming down and getting ready for sleep?
I'm starting to wonder if some of your issues have more to do with your hormones being out of whack. I don't doubt that Zoloft is causing some problems, I just wonder, as you do also, if you would feel much better if your hormones were more balanced. I would stick it out with Zoloft until you figure out what's going on hormonally. Are you seeing a good endocrinologist? If not, it may be a good idea. Try to find one that is willing to work with biodynamic hormones or more natural/supplement remedies.
You may want to just sacrifice a few days and see how you feel taking 25 mg Zoloft first thing in the morning. I mean, it's just a few days, you can handle it.
Dropping that small of an amount should hardly do anything, good or bad, IMO. Just stay where you are at or to a 3 day experiment on 25mg first thing in the morning.
I understand you want to start feeling good on a medication before you start taking things like fish oil, but I'm starting to think you might be better off and get a better reaction from your meds if you start the fish oil now.
Morgan
Posted by Phillipa on October 18, 2010, at 20:59:25
In reply to Re: Possible issues with klonopin brand switch :(, posted by morgan miller on October 18, 2010, at 19:21:53
You do need to have balanced hormones. Very crucial. Phillipa
Posted by ed_uk2010 on October 18, 2010, at 22:32:25
In reply to Re: Possible issues with klonopin brand switch :( » morgan miller, posted by michelle41a on October 17, 2010, at 22:59:46
>What amazes me is that I can have such crazy side effects from such a small dose of Zoloft.
25mg of sertraline (Zoloft) generally leads to approximately 70% occupancy of brain serotonin re-uptake transporters. Adverse effects can (and do) occur at such doses in some patients. Whether you take a generic or Zoloft is not likely to make a difference, except to your wallet. The adverse effects are generally caused by sertraline itself, a potent SSRI, and not by the cellulose (or whatever) in the tablet. Since you are very sensitive to sertraline, it may be best to stabilise on the same generic if possible. Your pharmacist may be able to help with this.
The graph on the left shows the relationship between sertraline dose in mg/day and % occupancy at serotonin re-uptake sites in the striatum (part of the brain). Small changes in dose within the range of 0-50mg per day can produce large changes in occupancy. At usual therapeutic doses (50-100mg per day), sertraline produces around 80% occupancy, as is the case with all SSRIs. Due to individual differences, lower doses are appropriate for some patients. Medicine would be a lot easier if everyone responded to the same dose, but this is unfortunately not the case. If sertraline does not work out, there are plenty of other options.
http://ajp.psychiatryonline.org/content/vol161/issue5/images/large/M88F3.jpeg
Posted by ed_uk2010 on October 18, 2010, at 23:25:40
In reply to The potency of sertraline » michelle41a, posted by ed_uk2010 on October 18, 2010, at 22:32:25
..........and I see below that you're switching to a different medication.
Posted by morgan miller on October 19, 2010, at 0:49:20
In reply to The potency of sertraline » michelle41a, posted by ed_uk2010 on October 18, 2010, at 22:32:25
> >What amazes me is that I can have such crazy side effects from such a small dose of Zoloft.
>
> 25mg of sertraline (Zoloft) generally leads to approximately 70% occupancy of brain serotonin re-uptake transporters. Adverse effects can (and do) occur at such doses in some patients. Whether you take a generic or Zoloft is not likely to make a difference, except to your wallet. The adverse effects are generally caused by sertraline itself, a potent SSRI, and not by the cellulose (or whatever) in the tablet. Since you are very sensitive to sertraline, it may be best to stabilise on the same generic if possible. Your pharmacist may be able to help with this.
>
> The graph on the left shows the relationship between sertraline dose in mg/day and % occupancy at serotonin re-uptake sites in the striatum (part of the brain). Small changes in dose within the range of 0-50mg per day can produce large changes in occupancy. At usual therapeutic doses (50-100mg per day), sertraline produces around 80% occupancy, as is the case with all SSRIs. Due to individual differences, lower doses are appropriate for some patients. Medicine would be a lot easier if everyone responded to the same dose, but this is unfortunately not the case. If sertraline does not work out, there are plenty of other options.
>
> http://ajp.psychiatryonline.org/content/vol161/issue5/images/large/M88F3.jpegThis is good advice. Still, I felt a significant difference when I tried sertraline generic for a month. Not only did my stomach feel upset the entire time, but I did not feel as good. I understand you and others not seeing how there could be a difference between brand and generic other than the fillers, but there is. And if it is just the fillers, they are enough to change the way the drug reacts in the body-just enough to make a noticeable difference. Even my last psychiatrist believes there is quite a difference between brand and generic with some medications. He sometimes prescribes double the dose of generic fluoxetine if his patient is switching to it from brand Prozac.
Posted by morgan miller on October 19, 2010, at 1:36:17
In reply to Re: The potency of sertraline, posted by morgan miller on October 19, 2010, at 0:49:20
As Phillipa may have pointed out, it is Bioidentical, not Biodynamic. OOps : )
Posted by ed_uk2010 on October 19, 2010, at 13:18:22
In reply to Re: The potency of sertraline, posted by morgan miller on October 19, 2010, at 0:49:20
>And if it is just the fillers, they are enough to change the way the drug reacts in the body
I appreciate that there are occasionally differences between brands but this is undoubtedly a topic which receives a excessive amount of attention. It is to be expected that people will believe that more expensive brands are superior. The immense impact that this perception has on patient response should not be underestimated. What people may not realise is that Zoloft, Prozac and other brands still only cost a few cents per box to manufacture, like any mass produced off-patent medication. The inflated price is mostly profit for the manufacturer. Eli Lilly currently sell branded Prozac in the UK for only £1.50 per pack of 30 capsules. How they can justify the US price I do not know.
The excipients used in generics are sometimes the same as the brand, sometimes different. In all cases, bioavailability will be tested. Excipients have a substantial affect on the absorption of some drugs (eg. ciclosporin) but the excipients used in SSRI formulations are mostly inert. Most brands of generic sertraline in the UK have the same or very similar excipients to Lustral/Zoloft.
>He sometimes prescribes double the dose of generic fluoxetine if his patient is switching to it from brand Prozac.
That is not very sensible! Doubling the dose is a very substantial increase and I cannot imagine that it would be appropriate.
Posted by morgan miller on October 19, 2010, at 20:31:34
In reply to Re: The potency of sertraline » morgan miller, posted by ed_uk2010 on October 19, 2010, at 13:18:22
> >And if it is just the fillers, they are enough to change the way the drug reacts in the body
>
> I appreciate that there are occasionally differences between brands but this is undoubtedly a topic which receives a excessive amount of attention. It is to be expected that people will believe that more expensive brands are superior. The immense impact that this perception has on patient response should not be underestimated. What people may not realise is that Zoloft, Prozac and other brands still only cost a few cents per box to manufacture, like any mass produced off-patent medication. The inflated price is mostly profit for the manufacturer. Eli Lilly currently sell branded Prozac in the UK for only £1.50 per pack of 30 capsules. How they can justify the US price I do not know.
>
> The excipients used in generics are sometimes the same as the brand, sometimes different. In all cases, bioavailability will be tested. Excipients have a substantial affect on the absorption of some drugs (eg. ciclosporin) but the excipients used in SSRI formulations are mostly inert. Most brands of generic sertraline in the UK have the same or very similar excipients to Lustral/Zoloft.
>
> >He sometimes prescribes double the dose of generic fluoxetine if his patient is switching to it from brand Prozac.
>
> That is not very sensible! Doubling the dose is a very substantial increase and I cannot imagine that it would be appropriate.
>
>It's because he has seen what happens first hand in all his years of experience. Even my therapist has heard of the same approach with brand vs. generic fluoxetine.
I'm not buying the placebo effect. Not in my case at least. I never once thought generic would effect me the way it did. I was actually excited about not having to pay as much. Unfortunately, after a few days I began to notice a difference. I know it doesn't make sense, but with some people there is a significant difference, and it is NOT placebo. I admit, this is just my belief and my opinion. My old psychiatrist is a very very bright and rational guy. I think he and others in the field are starting to believe that there really is a difference and not one resulting from some placebo effect.
I agree that this issue needs a lot of attention before we can know for sure what is going on here.
Posted by Phillipa on October 19, 2010, at 21:25:16
In reply to Re: The potency of sertraline, posted by morgan miller on October 19, 2010, at 20:31:34
Up to isn't it 20% difference each way can sure cause a huge difference I feel. Phillipa
Posted by ed_uk2010 on October 20, 2010, at 13:33:15
In reply to Re: The potency of sertraline, posted by morgan miller on October 19, 2010, at 20:31:34
>it is NOT placebo
But it can be, although I'm not saying that it is in any specific case.
Posted by ed_uk2010 on October 20, 2010, at 13:34:33
In reply to Re: The potency of sertraline » morgan miller, posted by Phillipa on October 19, 2010, at 21:25:16
>Up to isn't it 20% difference each way can sure cause a huge difference I feel. Phillipa
I give up.
Posted by morgan miller on October 20, 2010, at 14:18:16
In reply to Re: The potency of sertraline » morgan miller, posted by ed_uk2010 on October 20, 2010, at 13:33:15
> >it is NOT placebo
>
> But it can be, although I'm not saying that it is in any specific case.I agree it can be. In the case where the effects of generic and brand are noticed over a long period of time, I believe the likeliness of placebo decreases greatly. Or, in the case where someone truly believes generic is just as good as brand and still experiences side effects and differences in effectiveness, as was the case with me.
Posted by morgan miller on October 20, 2010, at 14:18:57
In reply to Re: The potency of sertraline, posted by ed_uk2010 on October 20, 2010, at 13:34:33
> >Up to isn't it 20% difference each way can sure cause a huge difference I feel. Phillipa
>
> I give up.Lol
This is the end of the thread.
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