Luvox/Fluvoxamine experiences anybody?

I was prescribed Luvox - will taper down off escitalopram and taper up on the luvox over the next few weeks. I was surprised this was suggested, I expected a more commonly used SSRI like zoloft or something. My prescriber said this one should help me feel less tired and is a bit more activating than others, is good for OCD and PTSD. Just started the switch today with 15 mg escit (instead of my 20 mg normal amount) and 50 mg luvox. Will keep reducing the escit over time I guess.

Has anybody had a positive experience with this?

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Originally Posted by newb1234

I was prescribed Luvox - will taper down off escitalopram and taper up on the luvox over the next few weeks. I was surprised this was suggested, I expected a more commonly used SSRI like zoloft or something.

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As a generalisation while no antidepressant (AD) is intrinsically better/more effective than the others for a particular disorder the SSRI fluvoxamine (Luvox) and the TCA clomipramine (Anafranil) seem to have an edge over other ADs for OCD so Luvox is definitely worth a shot.

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Originally Posted by panic_down_under

As a generalisation while no antidepressant (AD) is intrinsically better/more effective than the others for a particular disorder the SSRI fluvoxamine (Luvox) and the TCA clomipramine (Anafranil) seem to have an edge over other ADs for OCD so Luvox is definitely worth a shot.

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Thank you, good to know. I hope it works well. So far definitely too early to tell, but I'm open-minded.

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Originally Posted by newb1234

I hope it works well.

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If it doesn't then switching to clomipramine should be considered ahead of another SSRI, or SNRI, imo.

These days it and the other older TCAs are much underrated mostly because many doctors have had little experience with anything other than SSRIs and SNRIs. The newer meds aren't popular because they are more effective, but because they are perceived to be safer in overdose, which isn't actually true of all of them, and because they tend to have fewer ongoing side-effects, though this also isn't always the case in practice.

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So far definitely too early to tell, but I'm open-minded.

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As this isn't your first AD it may take a little longer to kick-in than escitalopram did.

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Originally Posted by panic_down_under

If it doesn't then switching to clomipramine should be considered ahead of another SSRI, or SNRI, imo.

These days it and the other older TCAs are much underrated mostly because many doctors have had little experience with anything other than SSRIs and SNRIs. The newer meds aren't popular because they are more effective, but because they are perceived to be safer in overdose, which isn't actually true of all of them, and because they tend to have fewer ongoing side-effects, though this also isn't always the case in practice.



As this isn't your first AD it may take a little longer to kick-in than escitalopram did.

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That's interesting, nobody has ever suggested a TCA. You're right that SNRI and SSRIs are brought up for the most part. They suggested bupropion prior but I was concerned about my history of seizures when I was really young.

So far I just have a nagging headache right above my eyebrow today. I also was a little queasy this morning though that passed. It's been a long time since I went through start-up side effects.

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Originally Posted by newb1234

They suggested bupropion prior but I was concerned about my history of seizures when I was really young.

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Childhood seizures don't usually preclude taking bupropion, but while it can be a very effective for depression it is often too stimulating for those with anxiety disorders.

Btw - small supplementary doses, <=75mg, can ease SSRI induced sexual dysfunction.

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It's been a long time since I went through start-up side effects.

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As you're switching between SSRIs the side-effects shouldn't be as severe as when you began taking the first AD. They will likely to much shorter lived too.

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Originally Posted by panic_down_under

Childhood seizures don't usually preclude taking bupropion, but while it can be a very effective for depression it is often too stimulating for those with anxiety disorders.

Btw - small supplementary doses, <=75mg, can ease SSRI induced sexual dysfunction.



As you're switching between SSRIs the side-effects shouldn't be as severe as when you began taking the first AD. They will likely to much shorter lived too.

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Yes I hope you’re right. No headache today but some nausea on and off. Nothing unmanageable though.

The enteric nervous system, the mini brain which controls the gut and seems to be the boss in the brain-gut axis, is by far the most serotonergic organ of the body so can be impacted more by SSRIs than the brain between our ears. Ginger and/or vitamin B6 supplements may help.

Thank you! You got that right. It seems to be easing up a little. I am looking forward to hopefully getting my energy and motivation back but I know that could take time and a higher dose than 50 mg.

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Originally Posted by newb1234

a higher dose than 50 mg.

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Most need to take 100-150mg. The recommended maximum is 300mg.

If you're taking immediate-release fluvoxamine then spitting doses above 100mg/day into half morning and night may produce a better result and/or ease any side-effects. If the dose can't be exactly halved then taking the larger part at night is preferable. But discuss this with your doctor first as there may be reasons for you not doing this. It is less of an issue with the slow-release formulations.

I think it’s immediate release? It doesn’t say anything about slow release and is just a regular tablet. I’ll see my prescriber tomorrow. I felt really nauseous for a good 6-7 hours after taking it today.

Well the luvox was rough. I did end up getting to 100 mg a day and felt like my mood actually was better, but my anxiety was not. Also I just continued to feel nauseous every day after 6 weeks. I wasn't loving my prescriber, so I got a second opinion from a highly recommended provider and ended up switching over to him. He took the time to really explain everything so clearly, including giving me several options he thought would be appropriate (i.e. stay the course, try an SNRI, try an SSRI) and gave me pros and cons of each. It felt really collaborative, which I appreciated. I chose to taper down and switch to cymbalta (duloxetine). I'm finally fully off the luvox as of last weekend and just on 60 mg of cymbalta. We chose this because I also deal with a lot of chronic pain. It's been going alright now that I'm off the luvox - no more nausea!! Unfortunately for 10 days I also was on an antibiotic that was very hard on my stomach an eventually led to full body hives too so all in all was not feeling great for some time. But here I am now on the other side of it hopefully.

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Originally Posted by newb1234

I'm finally fully off the luvox as of last weekend and just on 60 mg of cymbalta. We chose this because I also deal with a lot of chronic pain.

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Under the circumstances a reasonable choice. It'll be interesting to see how it works out. Please let us know how you're doing on it.

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Originally Posted by panic_down_under

Under the circumstances a reasonable choice. It'll be interesting to see how it works out. Please let us know how you're doing on it.

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Thank you! It's been interesting ... Apparently this week I have had antidepressant discontinuation syndrome. My prescriber met with me Friday and said this is likely what I am experiencing even with the cross-taper... that luvox can be one of the harder ones to come off of. I had about 4 days where I felt dizzy, headaches, was having really bad night sweats. I thought I was sick but I had no congestion or sore throat. My last luvox was last week so the timing I guess coincides. I think it's starting to get a little better but I still am a bit sweaty at night and sometimes a little light headed. He said we will keep an eye on it just in case it is actually the cymbalta but strongly thinkts its ADS. What fun!

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Originally Posted by newb1234

Apparently this week I have had antidepressant discontinuation syndrome.

...that luvox can be one of the harder ones to come off of.

...He said we will keep an eye on it just in case it is actually the cymbalta but strongly thinkts its ADS.

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It could be either. There's no way of telling. However, I suspect it is the duloxetine mostly because of the sweating. Duloxetine has a much greater affinity to dopamine transporter molecules than fluvoxamine and this is thought to be the main trigger for AD induced excessive sweating. Serotonin's effect on blood vessel tone, constriction and dilation may also play a part with duloxetine being one of the most serotonergic ADs. The other symptoms, dizziness and headaches are fairly common initial side-effects of most ADs. In most cases these side-effects diminish within a couple of weeks.

Wow, that's interesting. Well whichever it was, I think it's getting better. I didn't sweat the last two nights knock on wood and the dizziness is way better than when I posted this. Hopefully I'm over the hump.

You know so much - what is your education/background? I have learned quite a bit from you!

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Originally Posted by newb1234

Wow, that's interesting. Well whichever it was, I think it's getting better. I didn't sweat the last two nights knock on wood and the dizziness is way better than when I posted this. Hopefully I'm over the hump.

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:) Fortune seems to have smiled on you because the sweats can take weeks to resolve, or be ongoing.

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You know so much - what is your education/background? I have learned quite a bit from you!

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I have no background in medicine beyond a first aid certificate many years ago. My degrees are in subjects far removed from healing. What I know I've learned from 37 years of dealing with my own PD and the experiences of many others in support groups like this one, plus communicating with anxiety/depression researchers.

Hah, well I wonder if it’s because I am on clonodine too? Maybe that is helping with the sweats a little. I hope they don’t come back. I feel a little more normal this week.

Honestly I have been around the block and then some with my own mental health and I work in the field. But I think my best training helping others is being a patient myself. Thanks for all your insights here.

Things are still much improved. I had a little bit of sweating the other night but also had tons of blankets on. Otherwise that has been a lot better. My sleep is much better too. Here's hoping the cymbalta is the right pick this time around.

That's great! :)