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Thread: Feeling fed up

  1. #321
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    Re: Feeling fed up

    Quote Originally Posted by panic_down_under View Post
    Oh, you wanted the good advice? You should have said something earlier, Sally.



    So you've been on 40mg for 7 weeks. Possibly still a little early to be getting the maximum benefit from it. How big is the gap between where you are and where you want to be?



    There will almost certainly be something that will work, but it could take some finding so more delay. :(

    Haha! You always give good advice!!

    Iím so close to being where I want to be- just donít feel 100% - more like 80%

  2. #322
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    Re: Feeling fed up

    Quote Originally Posted by Mrsmitchell1984 View Post
    Iím so close to being where I want to be- just donít feel 100% - more like 80%
    If you lived in the U.S. I'd be suggesting taking to you GP about adding a small dose of buspirone (Buspar), a GAD specific med which works great for some, but not at all for most, but which may increase the effectiveness of SSRIs/SNRIs and reduce some of their side-effects (it may also reinvigorate pooped-out ADs). However, GPs in the UK seem reluctant to prescribe it. The advantage is that if it works it tends to do so within 2-3 weeks.

    It wouldn't hurt to as your GP might be the exception that proves the rule. If not then increasing the fluoxetine dose will be your best bet.

    PS: if you get pushback on buspirone because it as flagged by the GP's interactions checker as causing serotonin syndrome when taken with SSRIs refer him/her to: Triptans, Serotonin Agonists, and Serotonin Syndrome (Serotonin Toxicity): A Review by one of the leading experts on the syndrome, Dr Ken Gillman.
    __________________



    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  3. #323
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    Re: Feeling fed up

    Quote Originally Posted by panic_down_under View Post
    If you lived in the U.S. I'd be suggesting taking to you GP about adding a small dose of buspirone (Buspar), a GAD specific med which works great for some, but not at all for most, but which may increase the effectiveness of SSRIs/SNRIs and reduce some of their side-effects (it may also reinvigorate pooped-out ADs). However, GPs in the UK seem reluctant to prescribe it. The advantage is that if it works it tends to do so within 2-3 weeks.

    It wouldn't hurt to as your GP might be the exception that proves the rule. If not then increasing the fluoxetine dose will be your best bet.

    PS: if you get pushback on buspirone because it as flagged by the GP's interactions checker as causing serotonin syndrome when taken with SSRIs refer him/her to: Triptans, Serotonin Agonists, and Serotonin Syndrome (Serotonin Toxicity): A Review by one of the leading experts on the syndrome, Dr Ken Gillman.
    Oh wow-this is amazing- thank you PDU. My only concern about going up a dose is that they only let you go to 60mg here- so if that doesnít work - thatís a lot to wean off to try something new x

  4. #324
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    Re: Feeling fed up

    Quote Originally Posted by Mrsmitchell1984 View Post
    My only concern about going up a dose is that they only let you go to 60mg here- so if that doesnít work - thatís a lot to wean off to try something new x
    The only ADs which require a washout period when switching to/from them are the MAOIs and while they are often effective when nothing else works you're a long way from needing to consider them, Sally. For all other ADs most do well with either an overnight switch (to SSRIs/SNRIs), or via a cross-taper to everything else. In either case you would only lose a week or two, not months as with weaning off and restarting on the new med. Because you're on fluoxetine you may need to ease the dose back for a week or two to reduce plasma levels before switching, but its long half-life should limit any withdrawal symptoms.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  5. #325
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    Re: Feeling fed up

    Quote Originally Posted by panic_down_under View Post
    The only ADs which require a washout period when switching to/from them are the MAOIs and while they are often effective when nothing else works you're a long way from needing to consider them, Sally. For all other ADs most do well with either an overnight switch (to SSRIs/SNRIs), or via a cross-taper to everything else. In either case you would only lose a week or two, not months as with weaning off and restarting on the new med. Because you're on fluoxetine you may need to ease the dose back for a week or two to reduce plasma levels before switching, but its long half-life should limit any withdrawal symptoms.
    As always PDU your advice is so appreciated and a massive comfort to me. Thank you so much.

    Is there any particular drug I could go for next? I have only even tried fluoxetine (and St Johnís wort!!). My cousin has had citalopram with success and my other cousin has something completely different beginning with V I think but she had hallucinations I think and her mum (no relation to me) had post natal psychosis but recovered rapidly after spending too much. Thank you again PDU.

    oh a question has come to my head all of the sudden - it is worth finding out what type of depression you have - I know bipolar is on my dadís side (his half cousin). I worry sometimes that I have bipolar and so would need something a bit stronger. I am having one really good week (where I can function really well- I eat more, sleep well but my brain is full of good ideas for work and is hard to switch off) and two below average weeks, and one very low week. Itís better than being constantly low though I guess x

  6. #326
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    Re: Feeling fed up

    Quote Originally Posted by Mrsmitchell1984 View Post
    Is there any particular drug I could go for next?
    I suggest either citalopram, or escitalopram with a slight leaning to the first. Both have a pretty good track record for working when other SSRIs have pooped. Or maybe consider one of the TCAs, amitriptyline, or imipramine if also inhibiting noradrenaline, aka norepinephrine, reuptake is though a good idea. Imho, they are a better bet that the SNRIs venlafaxine and duloxetine.

    it is worth finding out what type of depression you have - I know bipolar is on my dadís side (his half cousin). I worry sometimes that I have bipolar and so would need something a bit stronger. I am having one really good week (where I can function really well- I eat more, sleep well but my brain is full of good ideas for work and is hard to switch off) and two below average weeks, and one very low week. Itís better than being constantly low though I guess
    That diagnosis should have been made at the beginning. What you write has a hint of mild bipolar, though the regularity isn't typical, but you really need to be evaluated in person by an expert. Those with bipolar don't usually need more powerful ADs, often just the opposite to contain the switch to mania which can sometimes be much harder to control than the depression part of the cycle.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  7. #327
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    Re: Feeling fed up

    Quote Originally Posted by panic_down_under View Post
    I suggest either citalopram, or escitalopram with a slight leaning to the first. Both have a pretty good track record for working when other SSRIs have pooped. Or maybe consider one of the TCAs, amitriptyline, or imipramine if also inhibiting noradrenaline, aka norepinephrine, reuptake is though a good idea. Imho, they are a better bet that the SNRIs venlafaxine and duloxetine.



    That diagnosis should have been made at the beginning. What you write has a hint of mild bipolar, though the regularity isn't typical, but you really need to be evaluated in person by an expert. Those with bipolar don't usually need more powerful ADs, often just the opposite to contain the switch to mania which can sometimes be much harder to control than the depression part of the cycle.
    Thank you PDU- I will ask for an assessment and look at using citalopram first. Thank you very much- where I have mainly had a shrug of shoulders or silence in response to my questions- itís so nice to have information. Thank you very much - I honestly donít know where I would have been if I hadnít spoken to you. X

  8. #328
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    Re: Feeling fed up

    Is there such a thing as mild bipolar?

  9. #329
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    Re: Feeling fed up

    Quote Originally Posted by pulisa View Post
    Is there such a thing as mild bipolar?
    Bipolar II is absent full blown mania though Sally's description would probably fall short of that and might be classed at around cyclothymia in the bipolar spectrum. I have a friend you has episodes of considerable energy and creativity which is short of mania interspersed with periods of not exactly depression, more lassitude. Would he qualify for a bipolar I or II, probably not, but he would likely be classed as being somewhere on the spectrum. He's happy enough with his life and has never sought a diagnosis so we'll probably never know.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  10. #330
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    Re: Feeling fed up

    Quote Originally Posted by panic_down_under View Post
    Bipolar II is absent full blown mania though Sally's description would probably fall short of that and might be classed at around cyclothymia in the bipolar spectrum. I have a friend you has episodes of considerable energy and creativity which is short of mania interspersed with periods of not exactly depression, more lassitude. Would he qualify for a bipolar I or II, probably not, but he would likely be classed as being somewhere on the spectrum. He's happy enough with his life and has never sought a diagnosis so we'll probably never know.
    cyclothmania sounds about right but the lows are a lot deeper than the highs - when I am feeling ok I am just functioning as normal - I may have a few ideas at work but I can’t do that when I am feeling low. The lows are quite deep to me- but I guess it would be considered mild as I can still work and get out of bed x

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