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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by porkpiehat on March 31, 2012, at 12:10:42
Hey guys...
Been on Celexa and lamictal for about 10 years (and a small dose of klonopin over the last 6 months). Doctor and I decided to switch to Zoloft with the hopes of decreasing sexual side effects, flatness, and obsessive thinking, as well as a tendency to "act out" with drinking etc.
The switchover (decreasing Celexa while slowly adding Zoloft) was beautiful: I could stay home and do chores, my sex drive doubled, I wasn't bending over backwards to please people. Concentration was a little better.
When we left behind the Celexa altogether at 50 mgs of Zoloft, I found an increase in irritability and extremely tiredness during the day (vs the activation I had read about). Then taken at night, there was raciness, imperative to drink and spend. Good sleep is hard to come by (I feel like I am lying awake and dreaming). The Klonpin got me through work, etc.
The Doctor says it's a failed experiment, and that it further confirms her suspicion of BPII. But then last night I had two drinks with no desire for more, and went home and did my taxes. These are the opposite of what I was complaining about!
Now we are discussing tapering a little on the zoloft and maybe doing a 50/50 with Celexa. I'm wondering about where the Lamictal role is. It used to activate me a little which was helpful with the Celexa, but how does it react with Zoloft...perhaps that is driving some of the over-activation etc?
I'm not ready to embrace the BPII or give up on the Zoloft.
Any thoughts or advice PLEASE?
Posted by Phillipa on March 31, 2012, at 12:36:58
In reply to Hey Zoloft, what's up...bipolar and lamictal?, posted by porkpiehat on March 31, 2012, at 12:10:42
You sound very functional to me as no way could I do taxes. But I do take a combo of 2 SSRI's. Why dx of bipolar II? Phillipa
Posted by sleepygirl2 on March 31, 2012, at 12:47:11
In reply to Hey Zoloft, what's up...bipolar and lamictal?, posted by porkpiehat on March 31, 2012, at 12:10:42
A lower amount of zoloft perhaps?
Posted by creepy on April 1, 2012, at 1:51:04
In reply to Hey Zoloft, what's up...bipolar and lamictal?, posted by porkpiehat on March 31, 2012, at 12:10:42
The first time I went from celexa to zoloft I went mixed and had to stop.
the second time it went pretty smoothly. I have less side effects on zoloft, but apathy is still a big one. It also doesnt help my depression so much as make me less aware of it, while the symptoms persist.
If it was me, I wouldnt go 50/50 on those two Id tinker with the dose of zoloft some more and see what it can do for you.
Fatigue can be a depressive symptom. It can come on so strongly youd think you were physically ill. Ive had it on both meds, but celexa seemed to help it more than zoloft.
How much lamitcal are you on? 200mg? Its not much of an anti manic, but it does help with depression usually.
Posted by phidippus on April 3, 2012, at 19:28:51
In reply to Hey Zoloft, what's up...bipolar and lamictal?, posted by porkpiehat on March 31, 2012, at 12:10:42
Your bipolar. The Lamictal will balance your mood and the Zoloft will help with depression and what sounds like some OCD.
Eric
Posted by porkpiehat on April 10, 2012, at 11:10:51
In reply to Re: Hey Zoloft, what's up...bipolar and lamictal? » porkpiehat, posted by phidippus on April 3, 2012, at 19:28:51
Switched the Zoloft back to mornings so I could sleep better. It is definitely activating, to the point of being racy a lot of the times. I've got half a verse from one song or another playing in a loop constantly in my head.
I am certain that I love the zoloft simply because I am not completely obsessed over every interpersonal interaction in my life. That is so freeing, and yet it isn't this fake "happy" that I normally associate with SRRI's
Now I just need to find out how to deal with the irritability. It's not the BLIND RAGE that I've had with things like Buspar or Wellbutrin. And to some degree I think it's healthy that I'm saying some of the things I'm thinking that I've always kept pushed down.
But as a massage therapist, I find myself racy during my sessions and quick-tempered, which makes it hard for me to work. It's not so bad in my day-to-day interactions or situations where I'm not already prone to annoyance.
On the Celexa, an adjunct of buspar really helped me with my focus and racing thoughts, but after a week or so irritability and sadness would really kick in and I'm talking EVERYTHING made me mad.
On the Celexa, Lamictal would activate and motivate me. It made me racy and in higher doses would eliminate any behavior except working on projects.
Now I feel like the Lamictal is sedating me. Weird...not sure where it even fits into my treatment right now. I'm also wondering if trying the Buspar again at small doses would help the raciness during my treatments. I'm scared that the rage might come back in spades seeing as it's always just under the surface. But it has a tendency of cutting into SSRI actions. For Celexa that was patience and "good feeling." Maybe on Zoloft it will be raciness??
I could also increase the klonopin as now I am taking such a low dose, to combat the raciness and anger, but I'm scared of the tolerance and apathy that could accompany.
TOO MANY VARIABLES!!! My pdoc is gone for three weeks. She thinks titrating in small doses of Celexa while cutting back some on the Zoloft is the way to go. But them I'm on two SSRI's, Lamictal, and Klonopin (which makes it hard to wake up in the morning even at the lowest doses). I think that's rabbit hole/Valley of the Dolls territory.I think I need a career change, as I've always resented having to take care of needy/high maintenance/weak people (past issues of course) but in the mean time I can't drive away all my clients with my short temper.
What is the take away?
-I want to keep the Zoloft to some degree. The interpersonal thing is going to save my life.-I don't want to be overmedicated.
-I worry that my pdoc has a tendency to over-diagnose and over-medicate. She bases her decisions of self-reporting and not talking to my psychotherapist. I however, over analyze and therefor might exaggerate a little in my self-reporting
-I'd love to stop managing/thinking about all this and return to living my life.
Posted by phidippus on April 10, 2012, at 16:05:56
In reply to Re: Hey Zoloft, what's up...bipolar and lamictal?, posted by porkpiehat on April 10, 2012, at 11:10:51
Buspar would not help with the edginess. Only lowering the Zolloft or increasing the Lamictal is going to help with the 'up' you have.
You could also add a small bit of antipsychotic - risperdal and invega are great for feelings of agitation.
Eric
Posted by porkpiehat on May 30, 2012, at 12:38:11
In reply to Re: Hey Zoloft, what's up...bipolar and lamictal? » porkpiehat, posted by phidippus on April 10, 2012, at 16:05:56
> Buspar would not help with the edginess. Only lowering the Zolloft or increasing the Lamictal is going to help with the 'up' you have.
>
> You could also add a small bit of antipsychotic - risperdal and invega are great for feelings of agitation.
>
> EricOy!!! After dealing with a crushing feeling of sadness on this weird zoloft/celexa mix (Neither or which was at a therapeutic dose), I am back up to 50 mgs of Zoloft and still 5mgs of Celexa (which I felt was ameliorating my anger...now who knows).
The lingering irritability and abrupt suicidal thoughts/depression made pdoc say "my lithium buttons are being pushed by this"
So after a weekend of feeling very activated (can't concentrate or read, but wanting to get a lot of things done and work out, have sex...much like when I started taking my lamicatal) I started a bedtime dose of lithium 150mgs...
I woke up very sad and yet nervous and uncomfortable. I discontinued but pdoc and pharmacist say this reaction is unlikely at that dose. It felt terrible. Pdoc thinks it is a reaction to the Zoloft as we are now at 2-3 weeks of 50mgs instead, and NOT the lithium.
I know I felt SOMETHING from the lithium as I was thirsty for most of the day and the bad feeling abated as the day went on.
She wants me to try again. Any thoughts? I was on Celexa w/Lamictal for 10 years and only switched because I wanted to try to address sexual apathy, obsessiveness, and the hedonistic side that it brought out in me.
Posted by creepy on June 7, 2012, at 6:49:04
In reply to Re: Hey Zoloft? with lamictal and now lithium?, posted by porkpiehat on May 30, 2012, at 12:38:11
celexa IS good on anger for some folks. Though a dose that small never did much for me. It took 40mg and higher to get that effect.
Zoloft works well on my irritability. Not sure if this is because I am still in a depressed state but I dont feel it. This drug is almost like a 'psychic painkiller' more than an AD.
The first time I tried to transition to zoloft from celexa I had a really bad mixed reaction. The second time wasnt bad. I went up slowly and stopped at 200mg. Less apathy and sexual dysfunction on this drug so far. Maybe use a PRN antipsychotic to calm the mixed stuff? Or raise lithium?
Irritability can be a sign of a mixed state. Doesnt necessarily mean you are BP. Lamictal wouldnt be my choice of drugs for that, its not so good on the manic side of things. Lithium would, but it also creates apathy.
Drugs that address apathy and anhedonia are likely to raise anxiety =(
Posted by porkpiehat on June 7, 2012, at 18:45:12
In reply to Re: Hey Zoloft? with lamictal and now lithium?, posted by creepy on June 7, 2012, at 6:49:04
> celexa IS good on anger for some folks. Though a dose that small never did much for me. It took 40mg and higher to get that effect.
> Zoloft works well on my irritability. Not sure if this is because I am still in a depressed state but I dont feel it. This drug is almost like a 'psychic painkiller' more than an AD.
> The first time I tried to transition to zoloft from celexa I had a really bad mixed reaction. The second time wasnt bad. I went up slowly and stopped at 200mg. Less apathy and sexual dysfunction on this drug so far. Maybe use a PRN antipsychotic to calm the mixed stuff? Or raise lithium?
> Irritability can be a sign of a mixed state. Doesnt necessarily mean you are BP. Lamictal wouldnt be my choice of drugs for that, its not so good on the manic side of things. Lithium would, but it also creates apathy.
> Drugs that address apathy and anhedonia are likely to raise anxiety =(> celexa IS good on anger for some folks. Though a dose that small never did much for me. It took 40mg and higher to get that effect.
> Zoloft works well on my irritability. Not sure if this is because I am still in a depressed state but I dont feel it. This drug is almost like a 'psychic painkiller' more than an AD.
> The first time I tried to transition to zoloft from celexa I had a really bad mixed reaction. The second time wasnt bad. I went up slowly and stopped at 200mg. Less apathy and sexual dysfunction on this drug so far. Maybe use a PRN antipsychotic to calm the mixed stuff? Or raise lithium?
> Irritability can be a sign of a mixed state. Doesnt necessarily mean you are BP. Lamictal wouldnt be my choice of drugs for that, its not so good on the manic side of things. Lithium would, but it also creates apathy.
> Drugs that address apathy and anhedonia are likely to raise anxiety =(So I've been doing 300 mgs of lithium and will keep at it for a week, I promised my pdoc. We also raised the zoloft to 75 mgs because the sadness was not improving. I'm not sure if the lithium is doing anything except making me thirsty and killing my workouts. The added Zoloft, however, seems to be working on the depression but I'm now realizing doesn't feel any different than Celexa did now that it's at a therapeutic dose.
So now it's less aggitation and more of a raciness and urge to drink. Super!
BTW I'm not sure what you meant by "mixed state"
Posted by chumbawumba on June 9, 2012, at 20:28:56
In reply to Hey Zoloft, what's up...bipolar and lamictal?, posted by porkpiehat on March 31, 2012, at 12:10:42
For what it's worth I had a reeeeealy bad reaction to Zoloft which I was prescribed before I was diagnosed with bipolar. The most suicidal I've ever felt along with hallucinations. Much later I was perusing over on Crazymeds and found this "The slight dopamine action Zoloft has makes it the worst Serotonin-[sorta-]Selective Reuptake Inhibitor to take if bipolar is known or suspected. Definitely the worst to have taken if bipolar was a surprise."
Um yeah no kidding. Just their opinion of course and your mileage may vary but it sure held true for me.
Posted by porkpiehat on June 21, 2012, at 10:55:25
In reply to Re: Hey Zoloft, what's up...bipolar and lamictal?, posted by chumbawumba on June 9, 2012, at 20:28:56
yeah my pdoc wants me to increase the Zoloft to deal with the sadness and suicidal thoughts and anger. She also wants me to be on Lithium which after a week felt like it was making matters worse and more "antisocial" (sic).
What did you end up doing? Did you choose another antidepressant or just take a battery of mood stabilizers?
I'm at 75 lamictal now for two weeks and my sex drive just fell away. I'm taking Klonopin and Lamictal also. The suicidal thoughts pop in around 5pm but go away with more Klonopin or a beer (same thing, right?)
I think the zoloft or the klonopin are the major contributors to the suicidal thoughts and sadness. Don't know which way to go!
Posted by chumbawumba on June 21, 2012, at 15:09:03
In reply to Re: Hey Zoloft, Klonopin, Lamictal » chumbawumba, posted by porkpiehat on June 21, 2012, at 10:55:25
There is a school of thought that believes that antidepressants are destabilizing for people with bipolar disorder. I'm not sure if that is true for everyone with bipolar but I think it's true for me, at least when it comes to anything that is SSRI-ish. This link gives some food for thought.
http://www.psycheducation.org/bipolar/controversy.htm
Right now I take trazodone and seroquel in low doses. I have a lot of trouble sleeping and the combo is like an elephant tranquilizer. Trazodone doesn't seem to push me over the edge like other antidepressants do.
I think one thing I've learned the hard way is to not change more than one thing at a time. If I do and I feel different then I don't know what made the difference.
I'm pretty sure benzodiazepines like Klonopin exacerbate depression. If you have severe anxiety though it's a tough call. If you have bipolar disorder though I would be wondering if an antidepressant like Zoloft is actually causing some of your anxiety.
I took Lamictal for a while at up to 400 mg per day and it didn't affect my sex drive. I would suspect the Zoloft as the cause of your decreased sex drive unless the decreased sex drive specifically occured only after adding Lamictal to the mix. You could try taking Gingko Biloba daily. That helped my sex drive. I really started to feel the improvement in sex drive at about four Gingko capsules per day.
Posted by porkpiehat on June 24, 2012, at 7:59:00
In reply to Re: Hey Zoloft, Klonopin, Lamictal, posted by chumbawumba on June 21, 2012, at 15:09:03
I am curious? what were you being treated for with the SSRI's? They eliminated your anti-depressants so I wonder if that's something I'd be eligible for.
Posted by creepy on June 25, 2012, at 8:35:36
In reply to Re: Hey Zoloft, what's up...bipolar and lamictal?, posted by chumbawumba on June 9, 2012, at 20:28:56
I had a bad reaction to it when I tried to cross-titrate from celexa. Now I do pretty good on zoloft at 200mg.
Supposedly it doesnt raise dopamine until you reach a pretty high dose. What meds were you on when you tried zoloft?
a mixed / manic response to a SSRI doesnt mecessarily mean you are bipolar. Maybe get another opinion? Depends on your situation, I know I would rather take the least amount of medication possible to function.
Posted by SLS on July 8, 2012, at 7:51:05
In reply to Re: Hey Zoloft, what's up...bipolar and lamictal?, posted by creepy on June 25, 2012, at 8:35:36
> a mixed / manic response to a SSRI doesnt mecessarily mean you are bipolar.
There remains some debate regarding this issue. Can you provide any citations that support your statement? I am still undecided, but am leaning in the direction of having SSRI-induced mania be an indicator of bipolar disorder.
Thanks.
- Scott
Posted by phidippus on July 11, 2012, at 18:24:58
In reply to Re: Hey Zoloft, what's up...bipolar and lamictal? » creepy, posted by SLS on July 8, 2012, at 7:51:05
Interestingly enough, some bipolar 2 patients can get by with treatment on an SSRI alone.
I have known some patients who have had manic states only as a response to SSRI treatment.
The nucleus acumbens seems to be the main culprit.
Eric
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