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Anxiety Community
This patient support community is for discussions relating to generalized anxiety, anxiety and eating, anxiety and sleeping, mood swings, and phobias.
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making final choice now Prozac or Elavil
by kcdem, Apr 11, 2008 09:45PM
I just went to the old quack psychiatrist today. I had been waiting for the appointment to discuss what I had learned on this forum and also what Ryan had suggested. Ryan suggested Elavil and gave me a taper schedule to get off the Zolft that I have been taking for about 3 weeks. I am ending the Zoloft because of the insomnia, agitation, stiff neck, and blurry vision and sexual side effects it seems to be causing. I do have generic klonopin for situational anxiety but have taken .05 mgs a few times just to get some sleep. I know that these effects may stop. All side effects but the insomnia seem to be lessening slightly but I am just not as calm and it does not seem to be worth it; thus my choice is final. I am starting my taper tomorrow. I now realize that the Prozac which I had only taken for about 3 months (first med ever and was feeling fine) was probably not ineffective. I thought it may have increased my anxiety or turned on me in some way. To clarify I had several traumatic events that happenned at the same time and I went into a 3 week panic attack (first extended panic attack ever) that resulted in 2 ER stays. After some horrible med trial and error I ended up with only the Zoloft .25 mgs daily and Klonopin for sutuational anxiety. I think my underlying condition is depression. I have had panic attacks before but this was a doozy. I also realized that when all the trauma happened I was smoking mucho weed. I doubt that helped with my anxiety or depression. I have always has the panic thing. If I get out of my comfort zone and I do not handle bad suprises well; but the panic usually passed whithin hours and or minutes. I stopped all weed and alcohol about 3 months ago.
The old Doc suggested dry cutting my .25 mg tabs in half for 2 weeks then resuming the Prozac. I asked about the Elavil and he said that I may have more side effects with that med but was not opposed to it. He basically just agrees with whatever I say. I have no idea what I am paying him for. I will get another psychiatrist, but they take several months to get in and many want a credit card (which I have but it seems weird) so time is of the essence.
The side effects that he thought may be worse with Elavil included dry mouth, constipation, and he seemed to think the numb noodle thing would be worse with Elavil. He did not try to talk me out of Elavil, he just gave me his thoughts.
I will take any feedback to help me with this choice I can get. I had NO problems with the Prozac and the sexual side effects subsided after a couple days, then all was well. As long as the Prozac will not enhance my anxiety. I am inclined to just do that. Ryan and others; do you think the simple 2 weeks at 12.5 mgs and then switching back to my 20 mgs of Prozac is the way to go?...kcdem
The old Doc suggested dry cutting my .25 mg tabs in half for 2 weeks then resuming the Prozac. I asked about the Elavil and he said that I may have more side effects with that med but was not opposed to it. He basically just agrees with whatever I say. I have no idea what I am paying him for. I will get another psychiatrist, but they take several months to get in and many want a credit card (which I have but it seems weird) so time is of the essence.
The side effects that he thought may be worse with Elavil included dry mouth, constipation, and he seemed to think the numb noodle thing would be worse with Elavil. He did not try to talk me out of Elavil, he just gave me his thoughts.
I will take any feedback to help me with this choice I can get. I had NO problems with the Prozac and the sexual side effects subsided after a couple days, then all was well. As long as the Prozac will not enhance my anxiety. I am inclined to just do that. Ryan and others; do you think the simple 2 weeks at 12.5 mgs and then switching back to my 20 mgs of Prozac is the way to go?...kcdem
I think that Prozac along with the klonopin sounds like the best way to go.
Good Luck,
Jerz
We all know that everyone responds differently to the meds, however. The problem with the meds is that you have to go through drug trials until you find what works best. Unfortunately, I wasn't aware how these trials can then affect your brain chemistry, many times affecting the results of the new drug that you're trying. I can't even begin to explain this, but Ryan has posted about this.
I don't know if I mentioned mirtazapine to you as a consideration if anxiety is part of the problem. It has sedating properties...it's not perfect....but it's in a class of drugs by itself - not a SSRI, but a tetracyclic.
I know the Elavil has a long track record of safety, etc., but again, Ryan is the expert on this and can certainly guide you in the right direction, if he's available.
Good luck, KC. If you did have success with Prozac in the past, I don't know why you wouldn't have the same success now. Unless your usage of Zoloft would somehow impact this. Ryan could certainly comment on this.
I hope you feel better soon - the drug trials can really take their toll on you.
Best,
-xan-
^quote
It's worth a shot in my opinion, considering the fact that you took Prozac for three months and had a favorable response to it.
The only potential problem is that the Prozac may no longer be fully effective, or it may be completely ineffective. You're probably asking yourself "how could that be, it worked before, so why shouldn't it work now?" Such a question warrants a great explanation:
Often times, folks will post on here who have tried various SSRI type drugs. Often, they will have had a favorable response to one SSRI (typically, the one they started on originally), only to be switched to another SSRI in which induced untoward effects. Then, when the original SSRI is restarted, it either carries more side effects than it did originally, is less effective, or completely ineffective. Why?
Despite their name, Selective Serotonin Reuptake Inhibitors are anything but selective. While they are selective for 5-HT (Serotonin) specifically, they lack specificity in regards to which 5-HT subunit they target. The ideal antidepressant would target 5-HT1:
-5-HT1 stimulation is associated with antidepressive and anxiolytic properties.
-5-HT2 stimulation is associated with nervousness, insomnia, and sexual dysfunction.
-5-HT3 stimulation is associated with nausea, headache, and all of the other adverse SSRI side effects.
SSRI's lack specificity as stated above, which means that they target all three of these neurotransmitters. High affinity for 5-HT1 is the goal, as it is the one associated with benefits. There is absolutely no way of knowing in advance who will respond favorably to an SSRI by showing high affinity for 5-HT1, so it's largely a guessing game on the doctor's part, and he had better guess good. If his guess is wrong, the patient will, more often than not, fail to respond to all SSRI's if he/she has an untoward effect to even one of them.
When you were originally started on Prozac, you had some side effects initially. This is proof that the drug was targeting both 5-HT1 and 5-HT2, however, the Prozac showed higher affinity for 5-HT1 and weaker affinity for 5-HT2, and your side effects vanished in short order.
Then, you were started on Zoloft, and experienced insomnia and sexual dysfunction. Unlike Prozac, the side effects remained. This means that for you, Zoloft shows higher affinity for 5-HT2 than it does for 5-HT1.
The concern with switching back to Prozac is Prozac's ability to continue to target 5-HT2, as all SSRI's lack specificity. The side effects that were fueled by Zoloft may continue to be fueled by Prozac. While Prozac showed only mild affinity for 5-HT2 originally, mild affinity is all that required to keep the sequence alive that was initially induced by Zoloft.
Short of actually trying the Prozac again, there is no way of knowing for certain how you will respond to it. So, it's worth a shot. If it doesn't work, a selective antidepressant will. When anxiety and depression coexist, Elavil, Pamelor, and Sinequan are the top choices. When depression alone dominates, Norpramin and Tofranil are the top choices.
Based on everything I've read from you, if Prozac fails, I'd recommend Elavil.
Take care,
Ryan
Ryan did mention that after taking the Zoloft that it could affect my new response to Prozac, I have only taken a small does of Zolft for a short time so I am hoping I will be ok. I have one friend who gets a sedative effect from zoloft...so who knows.
I would like to hear if anyone else has switched from an SSRI to Elavil or another tryciclicide (spell check please) or more people who have been on Elavil and or another in that class. So far I have got sleepy and drooling and those dont sound good.
I have tried Remeron as xanweaner mentions in generic form it was part of the med cocktail I was on, great sleep and some WILD dreams, but great sleep. Never had insomnia sober or weeding...kcdem
could I just start taking the Prozac tomorrow? When the doc switched me to Zoloft he stopped the prozac cold and said it would remain in my system a long time and my body would naturally wean itself.
only taken .25 of zoloft for 3 weeks, can I just stop it now and start on the 20mgs of the Prohizzle??????? kcdem
^quote
Bear in mind that the person who posted this was not prescribed the Elavil for its approved indication, nor do we have any idea what the dosage was. The Tricyclics (all of them), need to be started slowly (25 mg initially). The dosage is slowly increased to the standard maintenance dosage of 25 mg, t.i.d. or 75 mg total. If one were to start out on an excessively large dosage, problems could arise.
"I assume since I took it for several months and only stopped 3 weeks ago the Prozac still remains in my system."
^quote
A trivial amount of Prozac remains in your system. Whatever amount of Norfluoxetine remains in your system is no longer exerting a clinical benefit. Prozac has a very long half-life as compared to Zoloft, and Prozac requires at least one month to accumulate in the plasma before its full benefits can be appreciated. You weren't on the Zoloft for very long, and could probably make the switch back to Prozac without tapering the Zoloft. If you cannot tolerate a direct switch, you can use the taper schedule that we had discussed.
At any rate, act quickly, as the longer you remain on Zoloft, the less likely the Prozac is to work.
Ryan