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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by porkpiehat on February 18, 2022, at 12:10:31
I was thinking about trying a low-dose of prozac. I took it in the 90's so I was taking either 20 or 40 mgs.
I find celexa/lexapro less deadening but it makes me more prone to impulsive anger at low doses. Getting the dosing time is problematic too.
Big question is how it will react with the Lamictal. The Celexa/lamictal combo seems to intensify side effects of both and create more compulsiveness.
Also I used to get EXTREMELY suicidal if I had anything to drink on Prozac (especially the next day). Now this only tends to happen if I increase my klonopin dose or move some of it to the daytime.
I'm reading that prozac definitely has a GABA response so I'm wondering if this is the same phenomenon. I don't want the suicidality to get worse.
Anyway, just spitballing...Anyone have similar lamictal experience or a similar prozac vs celexa experience?
Posted by rjlockhart37 on February 18, 2022, at 16:42:18
In reply to back to Prozac maybe low dose, posted by porkpiehat on February 18, 2022, at 12:10:31
i take prozac with lamictal there both at max doses, 80mg with 400mg lamotragine seems to help with depression, and lamictal keeps me from going down into the depression phases. Lamictal at first i hated it, it was dulling and made my mood blant, i hated it. After time seems lamictal and prozac work well for depression. It just depends, prozac is my drug of choice for depression
Posted by rjlockhart37 on February 18, 2022, at 21:32:48
In reply to Re: back to Prozac maybe low dose, posted by rjlockhart37 on February 18, 2022, at 16:42:18
prozac i've been on since 2005. It change my life, out of depression but after years seemed to lose it's almost near hypo euphoria antidepressant feeling. So, now it just keeps me at baseline. It's used for bipolar 1 and is only approved for use in bipolar 1 (from what i read, there's many other sources)
Posted by Jay2112 on February 20, 2022, at 19:54:08
In reply to back to Prozac maybe low dose, posted by porkpiehat on February 18, 2022, at 12:10:31
> I was thinking about trying a low-dose of prozac. I took it in the 90's so I was taking either 20 or 40 mgs.
>
> I find celexa/lexapro less deadening but it makes me more prone to impulsive anger at low doses. Getting the dosing time is problematic too.
>
> Big question is how it will react with the Lamictal. The Celexa/lamictal combo seems to intensify side effects of both and create more compulsiveness.
>
> Also I used to get EXTREMELY suicidal if I had anything to drink on Prozac (especially the next day). Now this only tends to happen if I increase my klonopin dose or move some of it to the daytime.
>
> I'm reading that prozac definitely has a GABA response so I'm wondering if this is the same phenomenon. I don't want the suicidality to get worse.
>
> Anyway, just spitballing...Anyone have similar lamictal experience or a similar prozac vs celexa experience?
>
>
Hi porkpiehat,Well, I have had much experience with Prozac, as well as Celexa. All I have to offer is my personal experience, but will try to add in additional thoughts. Do you have a diagnosis, or can you mention what symptoms are most prevalent for you? Do you have any problems with mania, in particular dysphoric, a 'dreadful' type of mania? You mention being suicidal...have you ever tried an antipsychotic?
From the literature, Prozac does seem to affect GABA at medium to high doses. I believe this is why Prozac was effective with me, at the 40-60mg dose level. I imagine, in your case in particular, alcohol may have severely curbed GABA levels, and left you with the high norepinephrine and serotonin levels Prozac produces, possibly causing your suicidal response. (IMHO,etc)
Celexa is very serotonin selective, much more than Prozac, and does not have any real effect on GABA, norepinephrine, or any other neurotransmitter. Lamictal, the NMDA agonist, may or may not produce a bit of a flattening effect in a combination with Celexa.
Possibly, try starting Prozac on its own, since you had a positive response before? IMHO, I would start at the 40mg dose that you responded to before, as it is the medium to higher doses that produce the GABA stimulation.
My *major* concern, of course, for caution is with your suicidality. IMHO, an antipsychotic that you have tried, and has reversed suicidal feelings would be best to have on hand. Mostly, though, getting medication advice from your pdoc about your suicidal feelings is most important.
Please be safe, whatever you do.
Jay
Posted by Jay2112 on February 20, 2022, at 20:07:40
In reply to Re: back to Prozac maybe low dose, posted by rjlockhart37 on February 18, 2022, at 21:32:48
>polite snip< It's used for bipolar 1 and is only approved for use in bipolar 1 (from what i read, there's many other sources)
I believe you mean fluoxetine in combination with olanzapine (in combo known as Symbyax...but just as easily taken separately) It is used for depression in bipolar disorder.
Jay
Posted by undopaminergic on February 21, 2022, at 8:28:09
In reply to Re: back to Prozac maybe low dose » porkpiehat, posted by Jay2112 on February 20, 2022, at 19:54:08
>
> You mention being suicidal...have you ever tried an antipsychotic?
>I suggest trying lithium. There is some research that suggests it has anti-suicidal effects even at very low doses.
>
> Lamictal, the NMDA agonist,
>Lamictal seems primarily to be a sodium channel antagonist, an action that *reduces* the release of NMDA-agonists glutamate and aspartate.
-undopaminergic
Posted by Jay2112 on February 21, 2022, at 13:09:02
In reply to Re: back to Prozac maybe low dose, posted by undopaminergic on February 21, 2022, at 8:28:09
> >
> > You mention being suicidal...have you ever tried an antipsychotic?
> >
>
> I suggest trying lithium. There is some research that suggests it has anti-suicidal effects even at very low doses.
>
> >
> > Lamictal, the NMDA agonist,
> >
>
> Lamictal seems primarily to be a sodium channel antagonist, an action that *reduces* the release of NMDA-agonists glutamate and aspartate.
>
> -undopaminergic
>Yes, I mean't to write 'NMDA antagonist'...but actually, Lamictal *initially* increases glutamate, down-regulating it eventually. This may explain the initial overstimulating effects Lamictal has when you take it for the first 2-4 weeks.
Jay
Posted by undopaminergic on February 21, 2022, at 13:28:48
In reply to Re: back to Prozac maybe low dose » undopaminergic, posted by Jay2112 on February 21, 2022, at 13:09:02
>
> Yes, I mean't to write 'NMDA antagonist'...but actually, Lamictal *initially* increases glutamate, down-regulating it eventually. This may explain the initial overstimulating effects Lamictal has when you take it for the first 2-4 weeks.
>I never noticed anything from lamotrigine (generic Lamictal), but that may mean it has the stabilising effect it is supposed to.
More glutamate does not necessarily mean "stimulating" in any subjective (or even observable) sense of the word. Dopamine is mainly an inhibitory (receptor subtypes D2, D3, and D4) neurotransmitter, but still it is associated with stimulation, as with psychostimulants.
The dopamine D3 receptor is the most closely linked to subjectively pleasant states of mind, and yet it is purely inhibitory. NMDA-antagonists, such as ketamine and memantine, can produce some effects resembling those of stimulants, but they are inhibitory too. It seems that inhibiting certain parts of the brain induces stimulation and/or pleasure. As if the activity of certain parts of the brain serve to weigh us down or possibly even selectively make us feel bad/worse. Maybe in the future a surgical treatment of depression might involve destroying some of these parts!
-undopaminergic
This is the end of the thread.
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