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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by dove on November 8, 1999, at 12:27:53
I am taking 20mgs Prozac w/ 40mgs Adderall and 75mgs Amitriptyline, and I am doing the crash and burn everyday since beginning the Prozac. One week so far and I know the aggravation and anxiety is theoretically going to pass but in the mean-time, I feel insane.
The Prozac and Adderall are being taken in the morning, the Amitriptyline before bed. I am real uptight during the day, massive adrenalin overload is what it feels like, and little suicidal thoughts popping in my head every so often.
Major crashing starts at 6pm, very sleepy, brain-dead, really hopeless and lethargic.
Amitriptyline is taken around 10pm, suddenly love life, smiling, warm fuzzy feelings for the entire family. Go to sleep happy, content and full of love. Wake up wishing I was dead. I feel strung-out in the morning and evening, like sick to my stomach, under the skin crawly, real bleak outlook at this point.
My anxiety is also hitting me pretty hard, pharmacist freaked out when she filled my script, stating the extreme danger of combining Prozac in particular w/ Amitriptyline and Adderall. I questioned her for specifics and it was all this P-540 something and she warned me of the risk of death. I know many of you are taking a cocktail of meds and the mgs are even higher, anyone ever get scared that their doc is using them as a guinea-pig?
I am having a hard time even writing coherently, will this go away soon?
dove
The amitriptyline has never felt so good, I wish I could take that in the morning w/ the prozac.
Posted by JohnL on November 8, 1999, at 14:44:58
In reply to Out-of-sorts w/Prozac/Adderall/Elavil(TCA), posted by dove on November 8, 1999, at 12:27:53
Hi Dove. There are enzymes that break down the drugs we take. Prozac strongly inhibits a particular enzyme that breaks down other drugs. It varies from person to person, but Prozac has the potential of drastically increasing the amounts of other drugs in the blood by interfering with their breakdown. This may apply to the Adderall, but it definitely applies to the Amitriptyline. When you introduced Prozac into your system, you basically increased the doses of the other meds anywhere from 2 to 11 times all at once. That's why you're feeling so out of sorts.
The combination of meds you are taking looks OK to me. Nothing weird here. But one must be aware that Prozac will increase the blood levels of other drugs, exactly as if you had increased the doses of them all. Personally I would bring the Prozac way back down to perhaps 5mg or 10mg a day (empty in water or juice to custom dose), or cut the doses of the others in half. TCAs are deadly in overdose, and the Prozac raises the TCA levels when combined. That's why the pharmacist was worried about killing yourself. To be safe, and comfortable with side effects, it sounds to me like the dose of the Prozac be reduced, or the others, or even everything. Get used to a certain level before tweeking higher. The doses you are currently taking are normal, but it's better I think to adjust to side effects at a lower level before moving up. 20mg Prozac, in addition to the other stuff, in just one week, would be pretty hefty to a lot of us.
Posted by dove on November 9, 1999, at 9:11:30
In reply to Re: Out-of-sorts w/Prozac/Adderall/Elavil(TCA), posted by JohnL on November 8, 1999, at 14:44:58
JohnL, You always have something helpful to add :-) I contacted my p-doc about turning the Prozac down a bit, but he said that I shouldn't because it will take even longer to get the full effects. I did feel a whole lot better yesterday afternoon, so maybe I'm thru the worst of it, today will tell.
If I emptied the prozac into water/juice, could I drink half in the a.m. and the rest in the afternoon or evening, would this help or just give me the same effects as the full morning dose?
Does Prozac have a peak concentrations like other meds, as in 6 hours after taken?
Is it alright to take Adderall and Prozac in the same mouthful in the morning? The pharmacist told me to take them an hour apart(take prozac 1st then Stimulant) but my doc said to take them simultaneously, why the different instructions?
Ahh.. life, what can you do but keep moving.
dove
Posted by dove on November 9, 1999, at 14:36:46
In reply to Thanx JohnL and a ? or two, posted by dove on November 9, 1999, at 9:11:30
I'm writing again, My resting heart rate is 160 from 12 noon on, right now it's 2:45 pm, my respiration is shallow/fast, maybe hyperventilating, I'm really dizzy. I feel like I'm gonna jump outa my skin, and I don't like it. I want these feelings to stop, I can't function like this. Is this a bad reaction to the prozac r what can I do to make it stop?
My head just keeps going and going, I can't stop moving and my eyes are not right either. not good.
dove
Posted by JohnL on November 10, 1999, at 4:04:46
In reply to Wired and feel like I'm gonna die, posted by dove on November 9, 1999, at 14:36:46
> I'm writing again, My resting heart rate is 160 from 12 noon on, right now it's 2:45 pm, my respiration is shallow/fast, maybe hyperventilating, I'm really dizzy. I feel like I'm gonna jump outa my skin, and I don't like it. I want these feelings to stop, I can't function like this. Is this a bad reaction to the prozac r what can I do to make it stop?
>
> My head just keeps going and going, I can't stop moving and my eyes are not right either. not good.
>
> doveI still believe that regardless of what any doctor says, we are ultimately in control. My pdoc gives me directions for dosing. But he also emphasizes that if I have a hard time with side effects at those doses, to cut them in half and go a little slower. He gives me persmission to 'play' with the dosing to fit my tolerance. I know what my ultimate dosing goals are, but I may not be able to get there as quickly as someone else.
I think your doc is wrong for pushing you this hard. A lot of treatment failures are due to noncompliance, which is due to intolerable side effects. Approaching dosing in a more conservative manner allows the body to adjust smoother and increases the odds the patient will stay with it and not throw in the towel. Whether you stay with the current dosing, or whether you back off and work up slower, the time lag for response isn't going to be much different. Maybe a week or two. No big deal in the whole scheme of things. Personally I would back off if I were you, with or without the doctor's blessings.
As for mixing Prozac in juice or water, yes you can drink some in A.M. and some later. Or if you're home, sip on it slowly all day. With its long halflife, this shouldn't theoretically make any difference. But in the real world, I find splitting the doses into smaller more frequent events to be noticably more tolerable. Certainly easy to experiment with. As for the other meds, taking them with Prozac or staggering them is also something you can personally experiment with to find out for yourself what works best, regardless of what anyone else 'thinks'.
Posted by Bob on November 10, 1999, at 5:13:12
In reply to Re: Wired and feel like I'm gonna die, posted by JohnL on November 10, 1999, at 4:04:46
> I still believe that regardless of what any doctor says, we are ultimately in control ... As for the other meds, taking them with Prozac or staggering them is also something you can personally experiment with to find out for yourself what works best, regardless of what anyone else 'thinks'.
JohnL scores again.
I apologize if you like your pdoc, dove, but I have no patience for docs who expect their patients to tough it out (i.e., suffer) while waiting for some effect to settle in that can vary widely from person to person. It's irresponsible. Grrrrrrrrr
JohnL is right about a lot of things, but the point he nails dead on is that we are in charge of our own bodies and what goes in them. I know, I know -- to do this, we *do* need good information to make informed decisions. Try asking your pharmacist about some of JohnL's practices, if you trust him enough. Your pdoc isn't listening well enough right now, so your pharmacist might be able to "fill out the corners" of the techniques mentioned here.
Of course, if you want to get your pdoc's attention, go sit in his office (if you can get there) the next time your symptoms are hitting you really hard. Let him explain that away.
That enzyme blocking action of Prozac's is nothing to play with. While your cocktail might look good in theory, we all know what happens inside your body can vary widely. For me, it was Prozac and Perphenazine. From what my pdoc told me, this combo is a known problem when people are at full therapeutic dosages of the Perphenazine ... like around, I'm guessing here, 80-100mg/day. I'm guessing because I was on 4mg, I *had* the adverse reaction, and my pdoc said it normally isn't seen unless you're getting 20x the dose I was on. It built up slowly for me, over six weeks ... sometimes these things just *don't* go away, especially when your system can't get rid of the stuff. I wound up in the ER (my therapist took me in), cogwheeling and in a constant state of panic. Some cogentin, some ativan, and a few days off of the perphenazine and I was fine for the first time in months.
Speaking of panic, I really don't mean to cause one here for you. I just don't want you to suffer through something that may not change with time.
be well,
Bob
Posted by Phil on November 10, 1999, at 6:13:38
In reply to Wired and feel like I'm gonna die, posted by dove on November 9, 1999, at 14:36:46
Dove,
Talk to your doc or cut the dose. I went to the ER in one of those fancy ambulances when starting, ramping, on Luvox. Exact same symptoms.
That is a scary feeling. I thought I was having aa heart attack. I take Clonazepam now, but if I didn't, I would keep some on hand in case another med does that.Phil
Posted by Bob on November 10, 1999, at 15:52:18
In reply to Re: Wired and feel like I'm gonna die, posted by Phil on November 10, 1999, at 6:13:38
>...I take Clonazepam now, but if I didn't, I would keep some on hand in case another med does that.
Me, too. It's been 13 months or so since that ER visit, and I've been on clonazepam ever since. It's my own little miracle. I forget to take it, I know by noon -- but I keep my "emergency box" with me and 20 minutes after taking my backup, the fear and tremors are gone.
Bob
Posted by Noa on November 11, 1999, at 4:32:44
In reply to Re: Wired and feel like I'm gonna die, posted by Bob on November 10, 1999, at 15:52:18
Dove, sorry I was not around when you posted about this reaction.
In 1984, I took my first dose of amytriptaline, 25 mg, and had a severe reaction that landed me in the emergency room: Concurrent super-hyped up feelings, bouncing off walls, with extreme feelings of sedation, muscle uncoordination, balance problems, slurred speech. Having these two seemingly opposite reactions concurrently freaked me out. I sometimes get a milder version of this on benadryl.
I have mild forms of this internal racing feeling. It feels awful. Yours sounds way more powerful, and intolerable. Definitely need to tell your doc you have to start slower. My doc, one of the good things about him, always starts me very very gradually on all meds. I guess he really listened back when I first went to see him, and he took my history, about my reaction to that amytriptaline.
The docs have a lot of expertise, but ablsolutely NO DIRECT KNOWLEDGE of how it feels to be in YOUR BODY. In that respect YOU ARE THE EXPERT.
Posted by dove on November 11, 1999, at 8:25:51
In reply to Re: Wired and feel like I'm gonna die, posted by Noa on November 11, 1999, at 4:32:44
Thank you all for your wise suggestions. Yesterday I dumped the prozac in a glass of water, sipped on it until about 2 in the afternoon and skipped 20 mgs of Adderall, and I did not have the racing heart/heart attack that I was having every afternoon. Mood swings also stopped, so that was good, Yeah!
Today, I took the whole Prozac in the morning and will skip 20 mgs of Adderall again, then we will see if it's the Prozac or the combo of SSRI/Stimulant/TCA.
Thank you all for being there, I really appreciate having the opportunity to sound off and receive "sound-bites" from experienced wise-ones. Love to you all!
dove
Posted by AMY II on November 18, 1999, at 17:25:05
In reply to Alive and still kickin' [Thanx], posted by dove on November 11, 1999, at 8:25:51
> Thank you all for your wise suggestions. Yesterday I dumped the prozac in a glass of water, sipped on it until about 2 in the afternoon and skipped 20 mgs of Adderall, and I did not have the racing heart/heart attack that I was having every afternoon. Mood swings also stopped, so that was good, Yeah!
>
> Today, I took the whole Prozac in the morning and will skip 20 mgs of Adderall again, then we will see if it's the Prozac or the combo of SSRI/Stimulant/TCA.
>
> Thank you all for being there, I really appreciate having the opportunity to sound off and receive "sound-bites" from experienced wise-ones. Love to you all!
>
> doveDove, AMY II here. Your eyes. what do you mean by your eyes not being right. And geese this is the first time i have ever read on this bored here you were going through a rough time. I am really sory hopefully things will get better. I have been out of touch, ( bus with lifes obstacles) but I am here for you if you need to talk too.
TAKE CARE,
AMY II
Posted by dove on November 19, 1999, at 12:50:09
In reply to Re: Alive and still kickin' [Thanx], posted by AMY II on November 18, 1999, at 17:25:05
The first week of adding in the Prozac was really bizarre to say the least. I cut the Prozac in half for one day and the Adderall in half for two days and have had no real problems since, and am taking everything in the proper amounts.
My eyes would stare at nothing and I would try to refocus and I was like blank again. My sight was in slow-motion while my body was double-time. It freaked me out right quick :-) I can only imagine what you have been going thru if I freaked with only that!
How are you doing? I hope you're still improving? I really appreciate that you noticed me on this big board, thank you :-)
dove
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