Posted by bleauberry on February 22, 2012, at 4:22:48
In reply to Re: luvox anhedonia/side effects/onset of action, posted by n_shrimpie on February 21, 2012, at 18:05:54
Ok that's helpful. Based on everything you have said, odds are very strong that ssris are not the way to go for you. That includes prozac, luvox, paxil, zoloft, celexa, lexapro, pristiq, effexor, cymbalta. None of those are anti-anhedonia meds, and in fact usually make anhedonia worse.
That said, any of them can behave entirely different when combined with a norepinephrine med, such as nortriptyline, desipramine, savella. Anhedonia almost by definition points a finger at norepinephrine and/or dopamine. It's more complicated than that obviously, but that's the basic landscape.
Anhedonia was my biggest thing too. Probably the single most effective med I had for that was Savella low dose.
And this suggestion really could work.....as you are continuing to reduce prozac, go ahead and add in Rhodiola Rosea. This herb is quite fascinating in multiple ways and happens to be fairly specific for your profile.
Lamictal probably isn't doing any favors either. The emotional spectrum is usually squashed on mood stabilizers.
The clues from your experience with ritalin and prozac suggest to me that the primary suspect in this case may be norepinephrine more than dopamine.
There WILL be weirdness as prozac washes out and especially as lamictal comes down. It could be fairly mild or it could be rather scary. Try to be in touch with it so you can know the difference between the withdrawal stuff and the actual disease stuff. As lamictal comes down the brain fog should improve but depression could temporarily show up as well....not disease depression but withdrawal depression. They are different but feel the same.
Back to your original question, is luvox a good choice when anhedonia is a primary concern? Not! That doesn't mean it couldn't work because in this game anything is possible, but the odds are not likely.
Any run of the mill GP might have had you on Wellbutrin instead. I mean, that one even though I think it is not a very good med, it is more specific for anhedonia. So if I were in your shoes making a list of where to go from here, my list would include: Rhodiola Rosea, Savella, Zoloft+Nortriptyline, Wellbutrin, Parnate.
> > I don't know if luvox has less sexual side effect than other ssris, about the same, or more. It is a ssri so the expectation of continued sexual side effects I think would be a realistic expectation. That's just what happens with those meds more often than not.
> >
> > A diffferent strategy would be to keep prozac as it is and add the missing ingrediets NE and DA. To do that might include nortriptyline, desipramine, savella, ritalin, adderall. They are all quite different but they all focus on balancing out the other transmitters in balance with what prozac is doing. I just think it's better to try a couple add-ons to a previously good med before abandoning.
> >
> > When my prozac got weak over time I added zyprexa and then shortly after that adrafinil (similar to modafinil) and I was pretty well for about 8 years. That was basically the same strategy....boosting the other transmitters (NE, DA or NE+DA) to balance out the prozac's predominant focus on serotonin.
> >
> > Luvox will keep the focus primarily on serotonin. The meds do have unique diffferences even though they are in the same family and do basically the same thing, so who knows anything is possible. If you are going away or something it would be a lot easier to add a tiny dose of something new to your existing prozac than it would to do a whole switch. imo
> >
> >
> the prozac never worked, only when it was washing out of my system. so we reduced it to 10mg thinking that there was a window of effectiveness, and it's not doing anything. doc wants to titrate me down from prozac while starting the luvox at 25mg but i think i should titrate down without any meds becasue what if the prozac works when it reaches 5mgs? so confused. tried adding abilify and ritalin did nothing. i'm also on 400 mg lamictal, which i've just reduced to 300 because of horrible brain fog and cognitive issues over the past year on the 400 mg. i don't have any sexual side effects on the 10mg prozac. my main depressive symptom is unabating anhedonia and the cognitive issues and sense of spaciness, though that may be due to the lamictal, who knows.
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poster:bleauberry
thread:1011074
URL: http://www.dr-bob.org/babble/20120221/msgs/1011157.html