Fluoxetine for 3rd time

[Ayresstew]

IÂ’m on day 17 and just increased 10 mg a few days ago had minimal side effects and last night felt like myself almost and having a joke which I was surprised then woke up anxious but Is that just a sign the message is starting to work and is a good sign

[panic_down_under]

While it is still early days it is promising sign.

[Ayresstew]

Hi it’s been a long time but would love your opinion or advice. I’m on week 10mg of Escitalopram now and so far I had minimal side effects just increased anxiety and depression week 4 my worst. I was on fluoxetine last time which seemed to react bad the 3rd time so was given lorezapam to help with the fluoxetine.
By week 6 on escitalopram my anxiety was improving and I started going out on my own , seeing customers about future work ect. I didn’t leave the house for 5 months before this even taking lorezapam. So this was massive improvement I could go anywhere. I hadn’t had any improvement in my mood or motivation all the way through also started a fast tapper on lorezapam and have been of that a few weeks.
For the first time 3 days ago my depression wasn’t there not really happy but definitely better and had 2 1/2 days where I had a more positive outlook and had some enjoyment so great especially as my brain has been going through withdrawals. I’ve seen people not get good improvement till 12 weeks onwards but do you think I’m better to stick at the dose with those new improvements even though it’s not every day or all the day but I haven’t had that in months. Doctor wanted to up my dose early on but I’ve never needed a high dose before. Through everything do you think these improvements can continue from 10 weeks my anxiety is very much under control
Thanks for your time

[panic_down_under]

I’m on week 10mg of Escitalopram now

How many weeks?

also started a fast tapper on lorezapam and have been of that a few weeks.

That's good because benzodiazepines (BZDs) such as lorazepam inhibit the mechanism by which antidepressants (ADs) work. However, I'm not a fan of fast tapers. Psychology is at least as important as chemistry and biology when quitting BZDs (or ADs) and slow tapers with small dose reductions are more likely to instil confidence in the process by minimising withdrawal symptoms.

I’ve seen people not get good improvement till 12 weeks onwards but do you think I’m better to stick at the dose with those new improvements even though it’s not every day or all the day but I haven’t had that in months.

As this is your third time on ADs the escitalopram may take longer to kick-in than the fluoxetine did the first and possibly the second time, though escitalopram's shorter half-line may counter this to some degree.

Doctor wanted to up my dose early on but I’ve never needed a high dose before.

For reasons which aren't really understood, ADs tend to become progressively less effective each time they are stopped and restarted so higher doses are often required to achieve previous levels of control.

Through everything do you think these improvements can continue from 10 weeks my anxiety is very much under control

So you are at week 10 on escitalopram? If so, you will likely still see some improvement in the next few weeks, but I suspect you will need a higher dose in the future.

While most would prefer to be on the lowest possible dose ADs don't directly affect anxiety (&/or depression) in the way BZDs do, or aspirin does with headaches. They work by stimulating the growth of new brain cells and it is these cells and the connections they form which create the improvement. This process requires a minimum dose to initiate and sustain it and in the absence of a readily available blood test to measure plasma levels being over medicated is better than under medication. Any excess ends up down the 'S' bend anyway.

[Ayresstew]

Sorry week 10

[Ayresstew]

Because I’ve been on antidepressants in the past I would probably need a higher dose ?
I never knew benzo stopped the antidepressant working or do you mean not as effective.
Does that apply for zopiclone as it’s a z drug

[panic_down_under]

Because I’ve been on antidepressants in the past I would probably need a higher dose ?

It is possible.

I never knew benzo stopped the antidepressant working or do you mean not as effective.

Anxiety disorders and depression result from a loss of brain cells in parts of the two hippocampal regions of the brain caused by high levels of stress hormones, particularly cortisol. It is essentially a type of auto-immune reaction which is also why both anxiety and depression may worsen when we are fighting an infection.

Both antidepressants and the cognitive, behavioural (CBT, REBT, etc) and mindfulness therapies stimulate the growth new brain cells by neurogenesis. The new cells and the connects they forge create the therapeutic response. This is why it takes weeks for ADs to work. It takes about 7 weeks for new cells to bud, grow and mature, though some improvement may begin a little earlier.

See also:

Chapter 6: What happens inside people’s brains when they’re depressed?

Chapter 7: Why do some parts of the brain atrophy during major depression?

Chapter 8: What is causing brain atrophy in depression?

Chapter 9: Some good news — anti-shrink molecules!

Chapter 10: All the Players on One Stage

Chapter 11: Can the Shrinkage Be Reversed?

Chapter 12: Putting it all together Genes, Stress, Depression and Atrophy — Conclusion

Unfortunately, benzodiazepines (BZDs) can significantly reduce the effectiveness of antidepressants by blocking hippocampal neurogenesis. ¹ In light of these studies benzodiazepines use should probably be limited to a couple of weeks when first taking antidepressants just to ease the initial increase in anxiety levels, for a while after AD dose increases for the same reason and thereafter for occasional breakthrough anxiety. If an antidepressant isn't adequately controlling anxiety on its own even at the maximum recommended or tolerated dose then switching to another which might be more effective should be considered ahead of supplementing it with a benzodiazepine. See also: the 'Ugly' part of Benzodiazepines: The Good, The Bad, and the Ugly

Does that apply for zopiclone as it’s a z drug

Depends on the med. Eszopiclone (Lunesta) seem to enhance maturation of hippocampal cells², at least in rats, but zolpidem³ has the opposite effect in acute administration, and no effect either way when taken daily. I don't know about zopiclone, or zaleplon. However, imo, this is not a good reason to take eszopiclone. Just as with BZDs the 'Z' class hypnotics are not good sleeping pills.


References:
[1]
Boldrini M, Butt TH, Santiago AN, et al. (2014)
Benzodiazepines and the potential trophic effect of antidepressants on dentate gyrus cells in mood disorders.
Int J Neuropsychopharmacol. Dec;17(12):1923-33 (Abstract | Full text)

Sun Y, Evans J, Russell B, et al (2013)
A benzodiazepine impairs the neurogenic and behavioural effects of fluoxetine in a rodent model of chronic stress.
Neuropharmacology. Sep;72:20-8 (Abstract)

Song J, Zhong C, Bonaguidi MA, et al (2012)
Neuronal circuitry mechanism regulating adult quiescent neural stem-cell fate decision.
Nature. Sep 6;489(7414):150-4 (Article | Study full text)

Wu X, Castren E. (2009)
Co-treatment with diazepam prevents the effects of fluoxetine on the proliferation and survival of hippocampal dentate granule cells.
Biol Psychiatry. Jul 1;66(1):5-8 (Abstract)

[2]
Methippara M, Bashir T, Suntsova N, et al (2010)
Hippocampal adult neurogenesis is enhanced by chronic eszopiclone treatment in rats.
J Sleep Res. Sep;19(3):384-93. (Full text)

Su XW, Li XY, Banasr M, Duman RS. (2009)
Eszopiclone and fluoxetine enhance the survival of newborn neurons in the adult rat hippocampus
Int J Neuropsychopharmacol, Nov;12(10):1421-8 (Full text)

[3]
Takase LF, Fornal CA, Jacobs BL. (2009)
Effects of the hypnotic drug zolpidem on cell proliferation and survival in the dentate gyrus of young and old rats
Brain Res Mar 9;1259:26-31 (Abstract)

[Ayresstew]

What’s that mean on the eszopliclone enhance the cells as in shouldn’t hinder the effect of the antidepressant. Zopiclone is very similar to this like escitalopram and citalopram

[Ayresstew]

I’m going to leave increasing my dose for about 4 weeks so week 14 to see if I get any more improvement. If I go up will it be as long for results because I’ve see people in 3-4 weeks having improved but thought it would be at least 6 weeks

[panic_down_under]

What’s that mean on the eszopliclone enhance the cells as in shouldn’t hinder the effect of the antidepressant. Zopiclone is very similar to this like escitalopram and citalopram

It may be very similar, but just as with citalopram and escitalopram there can be differences that might include their impact on neurogenesis. I haven't been able to find any data on zopiclone so would be wary of using it especially as there are better meds for insomnia, especially SSRI/SNRI induced insomnia, such as trazodone and mirtazapine.

I’m going to leave increasing my dose for about 4 weeks so week 14 to see if I get any more improvement.

I'd be making that call at 12 weeks, but it's your choice.