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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 11 to 35 of 38. Go back in thread:
Posted by SLS on April 17, 2011, at 5:24:10
In reply to Re: Prozac and Anafranil, posted by kolwolf on April 16, 2011, at 16:00:40
> Interesting. Perhaps the two together, at small doses, will be more effective sooner than one or the other at a higher dose?
That's a hard one. I tend to doubt it, at least according to my own observation. It seems to me that you would need full therapeutic dosages of both drugs. However, I would remind you that a therapeutic dosage of clomipramine is that which produces a blood level of about 150-300 ng/ml for depression and 200-400 ng/l for OCD. That could be as little as 50mg of clomipramine when combined with Prozac. Use blood tests. These values are consistent with most of the medical literature on the topic. I saw nothing that would lead me to believe that serotonin syndrome is a likely outcome. There are people on Psycho-Babble who believe that lower dosages are ideal. I would want to see evidence of this contention, though.
- Scott
Posted by Roslynn on April 17, 2011, at 12:33:28
In reply to Prozac and Anafranil, posted by kolwolf on April 15, 2011, at 18:59:04
Hi,
The combo of Prozac and anafranil is/was successful for me. I believe there is some risk of serotonin syndrome, so taking the lowest dose of each drug, if you are going to take them together, would be good.
Roslynn
> Hi,
>
> This is my first post here. I went to a psychiatrist for the first time today, and he prescribed me Prozac (20mg), Anafranil (25mg), and Klonopin (0.5mg) for my OCD, anxiety, and depression.
>
> I have not started taking them yet, but I just read that it is potentially very dangerous to combine an SSRI with a TCA. The doses are all low, and I'd like to think my pdoc knows what he's doing, but the things I've read worry me greatly. Is this a safe combination at those doses? I have not yet had a chance to share my fears about it with him.
>
> I have read a few anecdotal experiences about success with the two, but in general there seems to be very little on the internet about the combination.
>
> Thanks...
Posted by SLS on April 17, 2011, at 17:20:21
In reply to Re: Prozac and Anafranil, posted by Roslynn on April 17, 2011, at 12:33:28
Hi Roslynn.
> The combo of Prozac and anafranil is/was successful for me. I believe there is some risk of serotonin syndrome, so taking the lowest dose of each drug, if you are going to take them together, would be good.
What dosages did you use?
- Scott
Posted by Phillipa on April 17, 2011, at 20:59:50
In reply to Re: Prozac and Anafranil » kolwolf, posted by SLS on April 17, 2011, at 5:24:10
Scott my pdoc now uses much lower doses of meds to start. Asked her why and she said that if you can lessen or prevent side effects more people are likely to keep taking a med. Phillipa
Posted by SLS on April 17, 2011, at 21:57:28
In reply to Re: Prozac and Anafranil » SLS, posted by Phillipa on April 17, 2011, at 20:59:50
> Scott my pdoc now uses much lower doses of meds to start. Asked her why and she said that if you can lessen or prevent side effects more people are likely to keep taking a med. Phillipa
This is not a new concept.
Are there any differences in the final dosages arrived at? What are some examples?
- Scott
Posted by Roslynn on April 18, 2011, at 14:37:07
In reply to Re: Prozac and Anafranil » Roslynn, posted by SLS on April 17, 2011, at 17:20:21
Hi Scott,
I was on clomipramine 50mg and Prozac 60mg. But I also take lithobid, seroquel and ativan. The clomipramine was the last drug added to my cocktail and it was the one that finally had a positive result.
Right now I had a brief trial (unsuccessful) of Lexapro and am planning on going back to Prozac.
I hope all is well with you, Scott.Roslynn
> Hi Roslynn.
>
> > The combo of Prozac and anafranil is/was successful for me. I believe there is some risk of serotonin syndrome, so taking the lowest dose of each drug, if you are going to take them together, would be good.
>
>
> What dosages did you use?
>
>
> - Scott
Posted by SLS on April 18, 2011, at 15:22:33
In reply to Re: Prozac and Anafranil » SLS, posted by Roslynn on April 18, 2011, at 14:37:07
Hi Roslynn.
Did you ever get a blood level of clomipramine while you were taking 50mg?
> Hi Scott
>
> I hope all is well with you, Scott.
>
> Roslynn
Thanks for the well-wishes.Every day brings me closer to remission. I feel pretty good. I hit a plateau for about a week, but I am moving forward again. Improvement is very gradual. It might take another year before I recover 100%. This reflects the severity and length of my illness. I have observed that some people must wait four months before Nardil kicks in. I began to respond to it at the beginning of the fourth month. I am extremely fortunate.
Be well.
- Scott
Posted by Phillipa on April 18, 2011, at 19:41:45
In reply to Re: Prozac and Anafranil » Phillipa, posted by SLS on April 17, 2011, at 21:57:28
Scott depends on the person and their response. Mine doesn't feel coctails are What works just her opinion. For example fine to take what I do 50mg of luvox & 2.5 or 5mg of lexapro, and the lowe dose of benzos. Deplin is okay as a medicinal food and vitamins. I do remember when she would say give 50mg of luvox and raise it daily to maximum doseage. She has one patient still on an Maoi from years ago. I know she takes pristiq herself at the lowest dose and it works for her. You would have to ask her yourself what her maximum doses of a med are as can't speak for her. Just my own experiences with her. Back years ago prozac would have been a definite 20mg and now she presribes l0 or less of prozac to start. That's an example. Know cause one time she was going to give me some. Phillipa
Posted by SLS on April 18, 2011, at 20:12:32
In reply to Re: Prozac and Anafranil » SLS, posted by Phillipa on April 18, 2011, at 19:41:45
> Scott depends on the person and their response.
Doesn't it always?
> Mine doesn't feel coctails are What works just her opinion.
My opinion of her opinion is that she is doing her patients a great disservice by denying them proven effective treatment alternatives.
> You would have to ask her yourself what her maximum doses of a med are as can't speak for her.
I don't think that would be appropriate. My question to you is whether or not it is your doctor's practice to use subtherapeutic dosages of the drugs she prescribes. Is this what you were trying to convey?
- Scott
Posted by Phillipa on April 18, 2011, at 21:33:21
In reply to Re: Prozac and Anafranil » Phillipa, posted by SLS on April 18, 2011, at 20:12:32
No as I wrote starting doses. She doesn't encourage me to raise a thing. Does that answer better not sure but best that I have. Not all docs feel meds are the whole answer as she utilizes a lot of therapists in her practice and also her sessions are over an hour if need be. Phillipa she feels it's my choice what dose or meds I take.
Posted by SLS on April 19, 2011, at 9:11:10
In reply to Re: Prozac and Anafranil » SLS, posted by Phillipa on April 18, 2011, at 21:33:21
> No as I wrote starting doses. She doesn't encourage me to raise a thing.
Great.
> Does that answer better
Not really. I wanted to know if she had become a believer in using substantially lower dosages of medication. If you don't know, you don't know.
> Not all docs feel meds are the whole answer
What does your doctor recommend for you besides medication?
> she feels it's my choice what dose or meds I take.
Great.
What do you think is keeping you from feeling the way you would like to feel?
- Scott
Posted by SLS on April 19, 2011, at 20:56:09
In reply to Re: Prozac and Anafranil » SLS, posted by Phillipa on April 18, 2011, at 21:33:21
No response?
http://www.dr-bob.org/babble/20110418/msgs/983250.html
- Scott
Posted by Phillipa on April 19, 2011, at 21:00:17
In reply to Re: Prozac and Anafranil » Phillipa, posted by SLS on April 19, 2011, at 9:11:10
Physical pain the combo of osteoarthritis in back, bone spurs, spinal stenosis, curvature of spine, and osteoporosis the fear that doing something wrong will cause a bone to break. Also the fact that even though I have six bands positive for lymes disease the infection control doc just doesn't know what to do as antibiotics can cause a multitude of problems themselves. Lack of medical insurance, pain after any excercise and I was an athlete all my life. I refuse to give that up. And seems from the google seaches have done that since pain meds are not prescribed here as the docs feel they are abused that surgery isn't an option as no healing with osteoporosis to correct the discs. No good bone to bond with. See neuro spinal doc in a bit over a week. Have a look at his site if you like. Carolina Neurosurgery and Spine. Dr Hunter Dyer is who I will see trained in France. Recommended from the foot and ankle doc when I fell over a cement abuttment that shouldn't have been placed where it was in a parking lot. Sprained my ankle. The Abuttment was removed two days later. A Lady ran over when saw me with the managers and said remove that my Mother fell two years ago and broke her back on this. I'ts the only one in any parking lot around shopping cart holders. So too much stress and extenuating circumstances in my life have literally knocked me down. Phillipa
Posted by SLS on April 19, 2011, at 21:18:42
In reply to Re: Prozac and Anafranil » SLS, posted by Phillipa on April 19, 2011, at 21:00:17
> So too much stress and extenuating circumstances in my life have literally knocked me down. Phillipa
Again, what prevents you from feeling the way you want to feel? Viewed another way, why has your doctor failed at making you feel better than you do right now? Have there been any treatment suggestions made by your doctor that you decided to forgo? Are you afraid of change?
"Change will come when the pain of staying the same is worse than the pain of change."
I hope you haven't given up.
- Scott
Posted by sigismund on April 19, 2011, at 21:36:30
In reply to Re: Prozac and Anafranil » Phillipa, posted by SLS on April 19, 2011, at 21:18:42
We're not quite as good as dead but we (PJ and I) are certainly over the hill. Some of it is just age and there is not such a lot you (we) can do about it. It's quite interesting, all the people I know who get cancer now, almost one a week (you might get something worth taking then, did wonders for my mother's depression). Dying takes a while too. So if you ever wondered why you are feeling bad........
Posted by Phillipa on April 19, 2011, at 21:44:29
In reply to Re: Prozac and Anafranil, posted by sigismund on April 19, 2011, at 21:36:30
Sigi and boy that hill is sure getting a lot taller would you say? PJ
Posted by sigismund on April 19, 2011, at 21:52:08
In reply to Re: Prozac and Anafranil » sigismund, posted by Phillipa on April 19, 2011, at 21:44:29
>boy that hill is sure getting a lot taller would you say?
Sure is. You don't feel that good, do you, and this is just the beginning. But what can you do?
I like the look of the world a lot more now that I know I will be leaving it soon.
Everything is soon now, and it wasn't once. Once it seemed like there was all the time in the world.
But things look (as opposed to feel) so much better. Young people, of course, but also colours and the sky and plants and clouds.
Posted by Phillipa on April 19, 2011, at 23:11:51
In reply to Re: Prozac and Anafranil » Phillipa, posted by sigismund on April 19, 2011, at 21:52:08
Sigi I'd like a time machine and go back 20 years. Think we could do that? PJxx
Posted by sigismund on April 20, 2011, at 0:37:29
In reply to Re: Prozac and Anafranil » sigismund, posted by Phillipa on April 19, 2011, at 23:11:51
Why 20? That was the beginning of the end. I want 58 and I want to be able to choose my parents.
Posted by SLS on April 20, 2011, at 5:05:43
In reply to Re: Prozac and Anafranil, posted by sigismund on April 19, 2011, at 21:36:30
> We're not quite as good as dead but we (PJ and I) are certainly over the hill. Some of it is just age and there is not such a lot you (we) can do about it. It's quite interesting, all the people I know who get cancer now, almost one a week (you might get something worth taking then, did wonders for my mother's depression). Dying takes a while too. So if you ever wondered why you are feeling bad........
At age 51, I am still looking to unleash whatever positive energy I have left in me. Depression has prevented this from happening since I was 17. I still feel young. I don't know at what age I would accept the status quo. I have some appreciation of how aging can shape the way one conceives hope and acceptance. I can only know me at age 51.It should be obvious by now that the questions I asked Phillipa were pointed and precipitated anger. Anger can be a very motivating emotion.
Phillipa: You can decline to answer my questions if you like. I wasn't aware that you had declared yourself dead. Am I being hard on you? You bet. I am frustrated for you. I want you to live free of anxiety for the years you have left. Perhaps I underestimate the pain you have suffered as a result of therapy for your mental illness. Under these conditions, I can understand how you would be reluctant to rock the boat. I am fortunate that my drive to be free of a hideous depression pushed me to look past the severe exacerbations of my condition that many drugs have caused. In reality, I have no choice but to continue trying new things, regardless of the number of treatment failures. Perhaps the severity of my depression leaves me no choice. If someone were to hold your hand over a flame, I bet you would struggle for your life to free yourself. This is how I experience depression.
While we are on the topic, what drugs made your condition worse? What drugs are you most afraid of?
- Scott
Posted by Phillipa on April 20, 2011, at 13:02:49
In reply to Re: Prozac and Anafranil » Sigismund » Phillipa, posted by SLS on April 20, 2011, at 5:05:43
There are no drugs I'm aware of for the physical pain and bone loss of osteoporosis, with spinal stenosis, bone spurs, curvature of spine. I see the neurosurgeon & spine doctor in a week or so. Combed his website and if osteoporosis no surgeries, no real excercise which is my life. Just the pain even with binder on. I did some research into reclast which is for osteoporosis and see it builds bone in men but only prevents fractures in females must be a hormonal thing. Plus the meds for this leave you worse than before. Google FDA brings up many hits. My physical health preceeds anything mental as when feel physically well also feel emotionally well. So no pysch med failed me my body failed me like my Mothers did. She once said lose your health you have nothing. Those words have been in my head my whole life as told to me at age two. I was determined to excercise, eat healthy, be active all the time and it didn't work. I've done what I can do. I'm at retirement age now so no working or even standing on feet for more than a while as pain and don't take pain meds and don't want to I want my health back. Phillipa
Posted by SLS on April 20, 2011, at 13:12:41
In reply to Re: Prozac and Anafranil » SLS, posted by Phillipa on April 20, 2011, at 13:02:49
Good luck on your doctor visits. I hope they can come up with a plan that is not invasive.
- Scott> There are no drugs I'm aware of for the physical pain and bone loss of osteoporosis, with spinal stenosis, bone spurs, curvature of spine. I see the neurosurgeon & spine doctor in a week or so. Combed his website and if osteoporosis no surgeries, no real excercise which is my life. Just the pain even with binder on. I did some research into reclast which is for osteoporosis and see it builds bone in men but only prevents fractures in females must be a hormonal thing. Plus the meds for this leave you worse than before. Google FDA brings up many hits. My physical health preceeds anything mental as when feel physically well also feel emotionally well. So no pysch med failed me my body failed me like my Mothers did. She once said lose your health you have nothing. Those words have been in my head my whole life as told to me at age two. I was determined to excercise, eat healthy, be active all the time and it didn't work. I've done what I can do. I'm at retirement age now so no working or even standing on feet for more than a while as pain and don't take pain meds and don't want to I want my health back. Phillipa
Posted by Roslynn on April 20, 2011, at 14:36:35
In reply to Re: Prozac and Anafranil - Thanks :-) » Roslynn, posted by SLS on April 18, 2011, at 15:22:33
Oops, missed this. I have not yet gotten blood levels for my clomipramine. I just switched pdocs. I might bring this up.
Scott, I'm glad you are doing a little better and got a good response to Nardil.
Roslynn
> Hi Roslynn.
>
> Did you ever get a blood level of clomipramine while you were taking 50mg?
>
>
> > Hi Scott
> >
> > I hope all is well with you, Scott.
> >
> > Roslynn
>
>
> Thanks for the well-wishes.
>
> Every day brings me closer to remission. I feel pretty good. I hit a plateau for about a week, but I am moving forward again. Improvement is very gradual. It might take another year before I recover 100%. This reflects the severity and length of my illness. I have observed that some people must wait four months before Nardil kicks in. I began to respond to it at the beginning of the fourth month. I am extremely fortunate.
>
> Be well.
>
>
> - Scott
Posted by floatingbridge on April 20, 2011, at 16:46:14
In reply to Re: Prozac and Anafranil » SLS, posted by Phillipa on April 20, 2011, at 13:02:49
>So no pysch med failed me my body failed me like my Mothers did. She once said lose your health you have nothing. Those words have been in my head my whole life as told to me at age two.
Phillipa, I know we, at least I, see the world through our (my) lenses ground by experience. What you wrote above stands out to me because you have
written about this before. I recognize it, with my ptsd-type lenses as one of those places, ptsd and jargon aside, that remain painful. Mother/daughter stuff, you helping your mother during her
illness. I wish you had someone or something to remove that memory for you.Geez. I'm in tears. What sigi wrote about life. Yes, I'm only 51, but that's past the
middle, and right now it hurts to stand upright. So what is there to look forward to? But I am not done yet.Yes, the trees, the colors, and young people. Young people are beautiful.
There are probably many faiths that practice this element; in my silly take on Buddhism, there is the refuge one can take in the good within ones self and in others. A Buddhist 101 thought I find useful is that my desire to be happy and the existence of that desire, is the proof
of my essential goodness. But that's my issue.I really like you Phillipa. You know that. I would love you to have more comfort in life. Whatever that takes. And I think you were very brave to write down your
list of symptoms and discontents. I have and still do spend do much time hiding.For some reason, I don't know, evolution or something, pain is seen sometimes as shameful. Why? I don't know. For me it can be. When I look at others in pain, however, I don't see why anyone need be. Our culture deals with pain very clumsily.
Wish sigi could get that time machine up and running. Think we could fit my parents and their parents in, too? Would three generations do the trick? Oh. My son. Make that four generations.
Are you able to get out on your bike? Or is it stationary?
I was determined to excercise, eat healthy, be active all the time and it didn't work. I've done what I can do. I'm at retirement age now so no working or even standing on feet for more than a while as pain and don't take pain meds and don't want to I want my health back. Phillipa
Posted by Phillipa on April 20, 2011, at 20:13:25
In reply to Re: Prozac and Anafranil » Phillipa, posted by floatingbridge on April 20, 2011, at 16:46:14
FB I will ride my bike through thick and thin and pain til the day I drop. I once in school had to write my obituary and I was 120 living alone in Florida across the street from a beach. I wrote I'd run til age 85 five miles a day then walked 5 miles a day. That day was sunny, beautiful out I sat on a bench had chest pain and died of a heart attack. But I remained active til the day I died and will again. Stubborn as I am. Always have been always will be. No one can take that freedom from me including any illness. Love Phillipa
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