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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Christ_empowered on April 25, 2011, at 14:18:08
OK, so I was thinking: maybe my problem is too much antipsychotic in the antipsychotic+ssri combo. I take 30mgs Abilify, 20mgs Celexa. The problem with reducing the Abiify is that I'm kind of prone to agitation and hyperkinetic issues, and Abilify is very clean, non-sedating, etc., but it takes a kind of high dose to calm me down.
So I was thinking...low-ish dose Zyprexa plus Prozac? The combo has been well-studied, and it seems like I could adjust the zyprexa component up or down, depending on my mood. I do have psychosis issues, but I think maybe 30mgs Abilify is a bit much. I was thinking 5mgs Zyprexa to prevent drug-induced agitation/mania and act as a tranquilizer, plus the Prozac to lift my mood and eventually soothe my anxiety (Abilify isn't very good at dealing with anxiety).
What do you guys think? Bad idea?
Posted by B2chica on April 25, 2011, at 14:41:25
In reply to maybe switch to symbyax?, posted by Christ_empowered on April 25, 2011, at 14:18:08
good to try but becareful and really watch yourself.
i tried it when it first came out (actually pdoc pushed it on me) the prozac made me end up with my very first hospital stay from severe (crying nonstop depression) and also have my very first true manic reaction.
the zyprexa has been tried and true for me. within a few days it completely kills anxiety. and boosts mood (even within 24 hours for me before).but that was just me. and i think it has worked for some. i think the problem most people had was syncing the right dosage dispersment.
For safety sake you might want to think about starting meds separately that way you can start and stop them separately to see reaction first. if the combo works and at what dosage then you can switch to symbyax for saving co-pay...best wishes.
b2c.
Posted by mtdewcmu on April 25, 2011, at 14:57:16
In reply to maybe switch to symbyax?, posted by Christ_empowered on April 25, 2011, at 14:18:08
Are you talking about going to Symbyax or going to Prozac + Zyprexa? I don't see a point in going to Symbyax until you know what combo works best, because all it does it limit your options.
Also, are you sure you need to change both your meds? Maybe you only need to change the Celexa or the Abilify. The thing I hate about Prozac is that it takes a whole month just to reach steady-state blood levels, and then if you stop taking it, it takes at least a week or two to exit your system. When I am suffering, I don't want to wait that long. The only two SSRIs I have been able to tolerate for an extended period have been Celexa and Paxil, and I only barely tolerated Paxil. So IME it doesn't pay to commit too much to a particular drug trial.
One of the few predictable features of the SSRIs seems to be the activating/sedating axis. Prozac and Zoloft are generally considered to be the more activating ones, so if you can tolerate Zoloft, that ought to be a decent proxy for whether or not you'll tolerate Prozac. In fact, Zoloft seems to be a better all-around drug than Prozac, so if you haven't tried Zoloft yet, I would definitely recommend trying that ahead of Prozac.
Hope something in here helps.
PS. One other thing: the cytochrome P450 interactions between psych meds are more often than not ignored by psychiatrists, but they can make a huge difference. Paxil is a super-potent inhibitor of CYP2D6, for instance, so adding or subtracting Paxil may affect your blood levels of your antipsychotic. Prozac is a weaker, but still significant, 2D6 inhibitor. Zoloft and Celexa don't mess with the P450 enzymes as much. Luvox is a potent inhibitor of several. I haven't done all the work of investigating the interactions you'll run into; that is for you to do. But I recommend keeping them in mind.
Posted by Phillipa on April 25, 2011, at 19:25:55
In reply to Re: maybe switch to symbyax? » Christ_empowered, posted by mtdewcmu on April 25, 2011, at 14:57:16
I remember several times where it was suggested to take prozac and zyprexa separately. So you can adjust the dose of each. Are you still anxious on your present combo. Don't want to add something right? Phillipa
Posted by Christ_empowered on April 25, 2011, at 20:00:15
In reply to Re: maybe switch to symbyax?, posted by Phillipa on April 25, 2011, at 19:25:55
I'm no longer terribly anxious. I don't feel the need to add anything to my present combo.
My problem is that I feel a little bit too tranquilized, like the antidepressant+tranquilizer combo is tilted a little too much towards the tranquilizer end. I guess it would make more sense to take zyprexa and prozac separately. Since I get my expensive meds online anyway, I could (after talking about it with my shrink) get lots of smaller olanzapine pills and get a fixed amount of Prozac (generic) at a local pharmacy.
I was thinking that since zyprexa is fast-acting, I could make as-needed adjustments in the dose; take, say, 2.5-5mgs when I'm more anxious+depressed, more when I'm running on the more agitated/manic/psychotic end of things.
Since my main problem is recurrent psychotic depression, with anxiety, it seems to me that I might benefit from a little less neuroleptic, but I'd still need something that would have anti-agitation properties. That's why I thought zyprexa would be good; the Prozac part of it kind of freaks me out, honestly (long half life, stimulating, etc.), but the combo has been well-studied, so...why not, right?
I guess I could adjust my current regimen. My problem is that Abilify is very effective as an antipsychotic, but its not that great for agitation, anxiety, or generally chilling out.
Maybe I should stick with what I have now? I mean, 30mgs/Abilify is a lot, but its just 1 pill daily, and its non-sedating, there's no EPS, I feel good, mostly...
I just don't know.
Posted by mtdewcmu on April 25, 2011, at 20:29:46
In reply to Re: maybe switch to symbyax?, posted by Christ_empowered on April 25, 2011, at 20:00:15
> Since my main problem is recurrent psychotic depression, with anxiety, it seems to me that I might benefit from a little less neuroleptic, but I'd still need something that would have anti-agitation properties. That's why I thought zyprexa would be good; the Prozac part of it kind of freaks me out, honestly (long half life, stimulating, etc.), but the combo has been well-studied, so...why not, right?
>My guess is that the choice of Prozac as the SSRI in Symbyax has more to do with the fact that they're both made by Lilly than that it's such a great combo. So why not try a better SSRI?
Posted by Phillipa on April 25, 2011, at 21:54:57
In reply to Re: maybe switch to symbyax?, posted by Christ_empowered on April 25, 2011, at 20:00:15
Maybe lower the abilify a bit and see? Phillipa
Posted by Christ_empowered on April 26, 2011, at 11:11:08
In reply to Re: maybe switch to symbyax? » Christ_empowered, posted by Phillipa on April 25, 2011, at 21:54:57
hey Phillipa..yeah, you're right; I should work with what I'm taking now, since it works well, instead of switching it up just b/c something else sounds better.
Posted by Phillipa on April 26, 2011, at 19:32:45
In reply to Re: maybe switch to symbyax?, posted by Christ_empowered on April 26, 2011, at 11:11:08
I'm so glad you have made this decision for now feel best. Phillipa
This is the end of the thread.
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