DEPRESSION WITH SEVERE ANXIETY AND MED PROBLEMS

DEAR DR. Again I am 60 years old;
I have written recently about my 14 month sudden bout with anxiety; controlled fine with Ativan until 4 weeks ago. Now going to MH IOP group and trying to get reg. therapy. I have tried 7 drugs, paxil,celexa,trazadone,lexapro,klonipin (klonopin),ambien,SAM-e.All with horrible side effects. I took prozac for 9 years and was told 6 months ago I had poopout. So I went off 5 months ago while trying new meds with horrific results. I wrote you about going back on prozac and you mentioned you thought it would work. The Dr.s I have talked to gave me hope as well. After taking Klonipin (klonopin) last week and wanting to die I decided I could not do this anymore; they wanted me to try Zoloft I just can't I am terrified. So I talked with my Psy., my therapist and two med. spclist. and told them I wanted to try going back to Prozac. One wants me to try 10mg. daily the other 10mg. every other day. I remember I took liquid Prozac in the beginning starting small.  Here is my problem. I took 10mg. prozac yesterday; it took every once of courage because I want it to work so badly I was frantic about starting it and it not working.  Although I didn't have the horrific side effects of the other drugs I still felt stong things, Yawns I remember those, lethargy, foggy head, weak,dry warm feeling (drinking lots of water) very slight ashtma feeling, strange feeling all over, like a supressed feeling. I pushed to function as I am determined it will work. I fear taking another 10mg today so I am going to ask for the liquid when I go to MH tomorrow. I want to know if you think a smaller dose starting off very slow would be better? Also how does the Ativan fit in; does it affect how the Prozac makes me feel. Will this Prozac start working again for me? Can I get off the Ativan after a few weeks of hanging in on the Prozac? Please write and let me know your thougts, will these side effects go away in time; I know I need weeks for results I just want to be able to get through those weeks. Could some of this be hormonal? Could hormone changes affect how the prozac works? I hope not! I take Estrace 1 mg. and Natural Progesterone cream with DP for *6 yrs. They seemed to have been helpful over the last 6 years. I would appreciate everything you can tell me and advise me for this problem. I am praying you can shed some light for me to see to the end of this horrible tunnel. Sincere and grateful thanks

[Roger Gould, M.D.]

I think you are on the right track and in very capable hands with the physicians you now have.  The small side effects you have will definitely go away in days to weeks, and ativan can be used until the prozac kicks in, and at that time you and your doctor will evaluate whether to continue that as an adjunct medication.  The prozac dose sounds right to me.

[StupidMe]

It is the correct way to start Prozac from a small dose and step up slowly; but it will take about 3 weeks to work. Ativan will only offset some of the side effects of Prozac and will not reduce the efficacy of Prozac. Hormone replacement therapy will no doubt help your menopause and your mood and you have to consult your gynecologist for its adjustment and regular physical examinations; it will not affect Prozac either.