Posted by King Vultan on September 9, 2004, at 9:53:04
In reply to Prozac 140mg - no improvement - time to switch?, posted by incessant void on September 9, 2004, at 4:33:01
Your dosages of Prozac and Ambien are extremely high; AFAIK, the recommended maximums for each drug are 80 mg/day and 10 mg/day respectively. If the Ambien doesn't work at 10 mg/day, my thought would have been to try something else rather than increase the dosage beyond 10. The same would be true of the Prozac at 80 mg/day, but I am not a doctor.
Yes, a TCA might be worth trying, particularly, considering that you would have a very long wait before being able to go on an MAOI. Your dosage of Prozac is so high, and this drug has such a long half life that you would probably want to wait six to eight weeks in between the last dose of Prozac and the first of an MAOI to avoid any chance of suffering serotonin syndrome. It would probably be more expedient to try a tricyclic, which would involve less of a wait. The two that are often recommended are nortriptyline or desipramine because these have the fewest side effects in the tricyclic class. Nortriptyline is the one that my pdoc tends to favor in certain cases where a person hasn't responded well to the SSRIs or Effexor. This is a moderately sedating drug that is selective for blocking norepinephrine reuptake. Desipramine is more activating, with an even stronger effect on norepinephrine. Either one might be worth considering.
Todd
poster:King Vultan
thread:388557
URL: http://www.dr-bob.org/babble/20040909/msgs/388638.html