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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by n_shrimpie on January 4, 2012, at 19:41:34
could a lower dose of prozac be more effective than a higher dose? after 4 weeks on 20 mg i stopped because it didn't wasn't working. It started working after it started washing out of my system, but stopped working after it was totally gone (4 weeks).
Posted by Phidippus on January 4, 2012, at 21:07:46
In reply to low dose prozac more effective AD than high dose?, posted by n_shrimpie on January 4, 2012, at 19:41:34
No, a lower dose will not be as effective.
Eric
Posted by Phillipa on January 4, 2012, at 22:00:22
In reply to Re: low dose prozac more effective AD than high dose? » n_shrimpie, posted by Phidippus on January 4, 2012, at 21:07:46
If extreme anxiety which I years ago experienced at 20mg then yes a lower dose might work. Phillipa
Posted by SLS on January 4, 2012, at 22:47:54
In reply to Re: low dose prozac more effective AD than high dose? » n_shrimpie, posted by Phidippus on January 4, 2012, at 21:07:46
> No, a lower dose will not be as effective.
I would have to agree. I have never seen a therapeutic window demonstrated for Prozac.
- Scott
Posted by SLS on January 4, 2012, at 22:51:13
In reply to Re: low dose prozac more effective AD than high dose?, posted by Phillipa on January 4, 2012, at 22:00:22
> If extreme anxiety which I years ago experienced at 20mg then yes a lower dose might work. Phillipa
Did you ever try a lower dosage of Prozac?
- Scott
Posted by godess on January 5, 2012, at 3:39:09
In reply to Re: low dose prozac more effective AD than high dose? » Phillipa, posted by SLS on January 4, 2012, at 22:51:13
20 mg is the recomended starter dose, an the theraputic dose for depression,If you depression is major who know,s what mg will work in different patient,s . Has i said before more mg greater side effect,s.Which can be devastateing to a sexual active person, you will need a very understanding partner.
Posted by bleauberry on January 5, 2012, at 8:26:57
In reply to low dose prozac more effective AD than high dose?, posted by n_shrimpie on January 4, 2012, at 19:41:34
There is a certain phenomenon that happens with some people and it has been reported here multiple times. With that phenomenon, what happens is a patient will feel surprisingly better while weaning off a med or shortly after stopping it....but as soon as it is totally washed out, their symptoms return.
It could be a lower dose is better for you, and maybe you saw a hint of that while weaning off the med. It might be worth a shot to try lower dosing. I have personally experienced with both meds and herbs there is a therapeutic window with just about all of them....too little does nothing, the right amount works good, too much doesn't work or makes things worse....but the key to understanding this topic is to accept the premise that each and every patient is uniquely and sometimes profoundly different in biological terms than the next patient. So when they say 20mg is the therapeutic dose of prozac, I laugh. It probably is the generally accepted dose for a majority of people, but that in no way means someone else might do best with 120mg, someone else with 5mg. Personally I felt best for months on just 10mg, and before that at 5mg, and only went to 20mg when those lower doses tended to poop out somewhat over months.
Hey one of my doctors has had patients do well with as little as 1mg lexapro....but of course we all know 1mg won't do anything it has to be at least 5mg but really 10mg, right? Wrong. No matter where we look in life, the crowd is usually wrong.
On the opposite extreme, someone I know takes 400mg of prozac per day....in that case it is for OCD not depression. The point is....400mg is unheard of, clearly grossly above the generally accepted highest dose range, and yet for this person it works and has hardly any side effects even at that incredible dose.
Extremes happen. Are you one? Is your extreme on the low side? Just questions to consider. Or was it just that weird phenomenon of stopping a serotonin med that did it?
At this point we don't know if prozac will work for you or what the right dose was. All we know is you felt better when getting off it and that it did not work at 20mg. So that leaves two options....try a higher dose to see what happens....try a lower dose to see what happens. Given that you already have some strong clues pointing to the lower dose, I would try that.
But of course the long halflife of prozac will make it trickier to switch to a different med if the prozac experiments don't work out. My gut instinct says what you experienced was the phenomenon, but there is enough doubt and suspicion to perhaps warrant a retrial at lower doses. Using juice, you can empty a prozac capsule into juice, stir it well (won't dissolve) and drink custom sized doses. This way you can make any size dose you want....1mg, 3mg, 7mg, whatever. Stays good in the fridge for a week but must be stirred well each time it is used.
As a final comment I wanted to say I am not a fan of straight up SSRIs. I am in the camp that believes if you want the most robust performance, the fastest performance, and the longest enduring performance, all SSRIs require a counterpart med to balance out norepinephrine circuits with the serotonin circuits. That usually means adding to the ssri right from the start....nortriptyline, desipramine, ritalin, reboxetine, amisulpride, or milnacipran. In choosing ssri for such combos, I favor either zoloft or prozac for a variety of reasons. In the case of zoloft, because of its lower drug/drug interactions. In the case of prozac because of its broad influence on other neurotransmitter circuits besides just serotonin.
Posted by n_shrimpie on January 5, 2012, at 14:17:13
In reply to Re: low dose prozac more effective AD than high dose? » Phillipa, posted by SLS on January 4, 2012, at 22:51:13
> > If extreme anxiety which I years ago experienced at 20mg then yes a lower dose might work. Phillipa
>
> Did you ever try a lower dosage of Prozac?
>
>
> - Scott
No, i didn't try a lower dose, but since it started working 3 days after i quit I thought that might be due to my reduced blood levels. i can't think of any other explanation.
Posted by n_shrimpie on January 5, 2012, at 14:22:02
In reply to Re: low dose prozac more effective AD than high dose?, posted by bleauberry on January 5, 2012, at 8:26:57
well now i'm back on 20 mg, have been for 10 days, and i feel nothing except anxiety. i'm sure i was experiencing that phenomenon that everyone else has. Is it possible that my brain took 5 weeks to change and adapt even though the levels were reduced after week 4? i'm so confused, i don't know if i should stay on the 20 mg to get my brain to change faster or if i should just go down to 10mg.
Posted by gadchik on January 5, 2012, at 15:20:01
In reply to Re: low dose prozac more effective AD than high dose?, posted by n_shrimpie on January 5, 2012, at 14:22:02
I vote for smaller doses.I did well on 25mg zoloft,and felt even better on 12.5mg.I have heard that anxious people do best on smaller doses.And I was very depressed when I began the zoloft,but ended up better than well.
Posted by Phillipa on January 5, 2012, at 18:40:42
In reply to Re: low dose prozac more effective AD than high dose? » Phillipa, posted by SLS on January 4, 2012, at 22:51:13
No have a bottle of l0mg tabs here now with all the other meds didn't take. Jan/P
Posted by Phillipa on January 5, 2012, at 18:46:10
In reply to Re: low dose prozac more effective AD than high dose?, posted by gadchik on January 5, 2012, at 15:20:01
Was this your very first antideressant? Jan/P
Posted by linkadge on January 5, 2012, at 20:56:54
In reply to Re: low dose prozac more effective AD than high dose?, posted by gadchik on January 5, 2012, at 15:20:01
Yes, I have always done well on lower doses. When I took celexa, 10mg was a theraputic dose. For me 10mg of prozac or 25mg of zoloft was also theraputic.
I have also had sucess with taking holidays, or taking medications on-off. For instance, I could take 10mg of fluoxetine every other day, or every third day.
There was a study done (I think it was on zoloft) which showed that a 5mg dose was as effective as 50mg with fewer side effects. Who knows, maybe a placebo effect.
Linkadge
Posted by Phillipa on January 5, 2012, at 21:46:39
In reply to Re: low dose prozac more effective AD than high dose?, posted by linkadge on January 5, 2012, at 20:56:54
That's what the pdoc at the time wanted me to do take 20mg of prozac every three days. I didn't though. Phillipa
Posted by godess on January 6, 2012, at 4:28:24
In reply to Re: low dose prozac more effective AD than high dose? » linkadge, posted by Phillipa on January 5, 2012, at 21:46:39
20mg every 3 days, jesus what a weird way to take prozac, in your body, comming out your body , going back in your body,my head is spinning thinking about it. Your told on the lable not to miss a dose,if he had said about 7mg every day, would have still been weird but a better option than 1 every 3 days.
Posted by linkadge on January 6, 2012, at 20:13:59
In reply to Re: low dose prozac more effective AD than high dose?, posted by godess on January 6, 2012, at 4:28:24
>if he had said about 7mg every day, would have >still been weird but a better option than 1 >every 3 days.
Prozac has a half life much longer than other SSRI's. I think the half life is in the range of 2-4 weeks. Yes, that means after a single dose of prozac, its still in your system weeks later.
Anyhow, due to the long half life, you can actually build up a steady state by taking in in longer dosing intervals. Ever heard of fluoxetine weekly? Lilly released a version of prozac that could be taken once a week. You can't do that with the other SSRIs.
Linkadge
Posted by godess on January 8, 2012, at 3:20:51
In reply to Re: low dose prozac more effective AD than high dose? » godess, posted by linkadge on January 6, 2012, at 20:13:59
i get what your saying link, but it still seems to me, like an alcholic that drinks 1 day an not the next , he still has alchol in his system if a heavy drinker.So he start,s to feel rough an tops himself up with more booze, i sort of look at it that way, Say if someone is on 100mg zoloft an he takes50mg in the morning an 50mg at night, that not right to me , the dose is 100mg in 1 go so the 100mg works its magic all day. 50mg in the morning is not enough even if topping up the other 50 mg at night. does that sound weird to you
Posted by n_shrimpie on January 9, 2012, at 12:07:54
In reply to Re: low dose prozac more effective AD than high dose?, posted by godess on January 6, 2012, at 4:28:24
I just read that prozac suppresses dopamine, and when it's washing out of your system you can have a dopamine rebound, and that's why i was able to feel pleasure 3 days after i stopped it. would the dopamine rebound have happened that quickly? Has anyone ever heard of this phenomenon? i'm on day 14 of my prozac and still complete anhedonia. i can't even get out of bed.
Posted by linkadge on January 11, 2012, at 20:15:17
In reply to Re: low dose prozac more effective AD than high dose?, posted by godess on January 8, 2012, at 3:20:51
>the dose is 100mg in 1 go so the 100mg works its >magic all day. 50mg in the morning is not enough >even if topping up the other 50 mg at night. >does that sound weird to you
The problem is that the drug does not stay at a fixed concentration between doses. After the drug is fully absorbed, blood levels start to drop.
So even if you took 100mg in the morning, you would not have that same amount in your system in the evening. With really short half-life drugs, you need multiple doses each day or the blood level drops too low.
Paxil is eliminated the most quickly. However, prozac takes much longer to be eliminated.
Posted by linkadge on January 11, 2012, at 20:19:01
In reply to Re: low dose prozac more effective AD than high dose?, posted by n_shrimpie on January 9, 2012, at 12:07:54
>on day 14 of my prozac and still complete
>anhedonia. i can't even get out of bed.You restarted? You can always try a lower dose. For some people, if the dose gets too high, it just doesn't work. I think the SSRIs can supress dopamine, but it probably depends on your initial biochemical makeup. If people start with a low serotonin / dopamine ratio, then the SSRI would probably work better.
I got by with 5mg of prozac and felt great. Better than 10mg.
Linakdge
Posted by Phillipa on January 11, 2012, at 21:06:28
In reply to Re: low dose prozac more effective AD than high dose?, posted by linkadge on January 11, 2012, at 20:15:17
I thought luvox was the fastest? Hence twice a day dosing? Phillipa
Posted by n_shrimpie on January 16, 2012, at 18:15:48
In reply to Re: low dose prozac more effective AD than high dose?, posted by linkadge on January 11, 2012, at 20:19:01
> >on day 14 of my prozac and still complete
> >anhedonia. i can't even get out of bed.
>
> You restarted? You can always try a lower dose. For some people, if the dose gets too high, it just doesn't work. I think the SSRIs can supress dopamine, but it probably depends on your initial biochemical makeup. If people start with a low serotonin / dopamine ratio, then the SSRI would probably work better.
>
> I got by with 5mg of prozac and felt great. Better than 10mg.
>
> Linakdge
>
yes i restarted 20 mg on Dec 21, and my anhedonia is awful. i can't even motivate enough to take a shower, and can barely get out of bed. i feel like a zombie, it's unendurable. I want to stop taking it so badly, but feel i need to give it the requisite 6 weeks since i didn't last time. Or i may reduce it now to 10mg, since on my first trial i felt best when it was washing out of my system. i started on 20 mg instead of 10mg because i thought the onset of action would be faster. i can't tell if my anhedonia is deppression or prozac related and i'm terrified that i'll get permanent, irreversible anhedonia from the prozac. should i just stop it altogether now? i've also been reducing my lamictal from 400 to 200 because i think it may be causing my cognitive fog, but don't feel any differently since i reduced it.
Posted by Kaybee01 on May 2, 2016, at 10:17:44
In reply to Re: low dose prozac more effective AD than high dose?, posted by bleauberry on January 5, 2012, at 8:26:57
Just found this post. Hopefully someone will respond. I used Prozac many years ago and it worked very well for me until it stopped working about 5 years later. My pdoc has me trying it again. Started 6 wks ago at 10mg and 2 wks later went up to 20mg. Started feeling nauseous and dizzy soon as I started 20mg. Trying to stay on it to see if it's going to work and if side effects will pass. It's not working for depression and still feeling sick everyday. So 2days ago I diluted the 20mg and took 10 mg and nausea has just about gone. My question is...in the post ..blueberry ..said its best in her opinion to take with another med, other than SSRI. Just wondering if you still feel the same. Thanks
Posted by Kaybee01 on May 2, 2016, at 10:19:39
In reply to Re: low dose prozac more effective AD than high dose?, posted by bleauberry on January 5, 2012, at 8:26:57
Just found this post. Hopefully someone will respond. I used Prozac many years ago and it worked very well for me until it stopped working about 5 years later. My pdoc has me trying it again. Started 6 wks ago at 10mg and 2 wks later went up to 20mg. Started feeling nauseous and dizzy soon as I started 20mg. Trying to stay on it to see if it's going to work and if side effects will pass. It's not working for depression and still feeling sick everyday. So 2days ago I diluted the 20mg and took 10 mg and nausea has just about gone. My question is...in the post ..blueberry ..said its best in her opinion to take with another med, other than SSRI. Just wondering if you still feel the same. Thanks
Posted by Ruuudy on May 4, 2016, at 20:09:07
In reply to Re: low dose prozac more effective AD than high dose?, posted by Kaybee01 on May 2, 2016, at 10:19:39
I'll be very interested to follow along with how the Prozac works out for you, especially if you continue at that reduced dosage.
I have been taking Prozac for 26 years, less a few brief months drug vacation to participate in a double-blind study on paroxetine (Paxil); I believe I recall being told I was indeed on the paroxetine, and a good indicator of that was that I couldn't go poo-poo, #2, dookie for at least a couple of weeks. Eeew,,, I can still taste all the orange Metamucil I had to drink!!!
The first drug we tried augmenting the Prozac with after having been on it for 3 or 4 years, just to try to get an additional boost, was clomipramine. I remember how that combo really seemed to put a big damper on my OCD symptoms; I think it was the highly sedating effects that forced me to eliminate the clomipramine.
The only other psychopharmaceutical Ive used to augment my Prozac, and still use to this day, is clonazepam. This was at the suggestion of Dr. Eric Hollander during a 1-time consultation when I flew up to NYC to visit him. It was around 1994 or 1995 when I went up to see him, but probably 10 years later before I asked my PCP to prescribe it for me. That PCP moved on and my new one has gotten sketchy about continuing to prescribe clonazepam, even though he wrote the prescription for a couple of years. I have had to find a new psychiatrist, which I have had one visit with and am very impressed and happy with.
I have been under a great deal of stress over the past couple of years. My dad was diagnosed with non-Hodgins Leukemia (Sezary Syndrome) a couple of years ago, and I was at his side the whole way thru. We lost him last July, and its been very difficult without him he was my mentor, my hero, my best friend, my business partner, and my father. We had worked in the same office of our family hardware store for the past 25 years. Of course, I miss him very much!
Along with this, I have put a huge burden of trying to double-up my workload by taking on his business tasks, and believe me,,, that 86-year old man worked circles around people half his age he came into the store 7 days a week up until two weeks before his death!My top priority and promise to him was that I would look after my 81-year old mom and that my older bi-polar sister would be taken care of. Its been challenging. Very challenging with my sister. I beg of her to seek a different psychiatrist because the one she sees is what my daughter has termed a drive-thru psychiatrist in & out in 15 minutes so she can see 4 patients an hour! I wont go into detail with my sisters treatment & meds just know that my wife & I have had to avoid contact with her as of the past couple of months because she has become very mean & derogatory towards my wife & daughter.
Ok, I teared up while writing those couple of paragraphs.
This stress & emotional turmoil has caused my dysthymic depression & anxiety to flare up. Im beginning to wonder if Im having Prozac poop-out. Im quite fearful of coming off the Prozac because I credit it for not only not having any superimposed MDD, but also for helping me remain strong throughout my dads illness.
Im in research-mode in search of knowledge to help improve myself. Thats how I came across this topic on Dr-Bob.org.
Before I discontinue the fluoxetine (Prozac), I believe it might be worthwhile to try some other various augmentation strategies: Wellbutrin?.
Perhaps it might be that my body needs more help regulating the dopamine or norepinephrine neurotransmitters?.
It was mentioned to me by a friend, that happens to be a pharmaceutical rep, that brintellix is showing promise. Thanks for letting me rant & rave!
Rudy
> Just found this post. Hopefully someone will respond. I used Prozac many years ago and it worked very well for me until it stopped working about 5 years later. My pdoc has me trying it again. Started 6 wks ago at 10mg and 2 wks later went up to 20mg. Started feeling nauseous and dizzy soon as I started 20mg. Trying to stay on it to see if it's going to work and if side effects will pass. It's not working for depression and still feeling sick everyday. So 2days ago I diluted the 20mg and took 10 mg and nausea has just about gone. My question is...in the post ..blueberry ..said its best in her opinion to take with another med, other than SSRI. Just wondering if you still feel the same. Thanks
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