Should I ask doctor to safely lower down medications?

[devansharora]

I am currently taking 80 mg of fluoxetine and 100 mg of fluvoxamine each day and have been on medications since about an year and a half
I now feel lack of confidence and hand tremors.

[specialmom]

just wanted to check in and see how all of this is going.  

[devansharora]

Thank you, sure
I had consulted another doctor, He told me that it's not written in the books but its normal to prescribe this combination (Fluoxetine + Fluvoxamine)
I then recently went to my current doctor and he added another medicine Lamotrigine 12.5mg (25/2) and has asked me to take it before sleep.

[specialmom]

Okay!  We aren't doctors and they as a group when it comes to psychiatry mix, add and mess around with medications for patients and the bottom line is finding something that works for you. Is the new med helping?  How are things going?

[devansharora]

Just started taking it from yesterday,
Throughout the day today I had felt more relaxed but I had also been less productive, I don't know if that's due to the medicine
Thank you so much

[Paxiled]

Are you saying you're on both Luvox and Prozac at the same time?  I'm sure there are folks who can handle such a combination, and if you've tried a lot of things and they didn't work, docs have to try unusual things.  But taking two ssris at the same time isn't usually done.  It raises a risk of something called serotonin syndrome, and you don't want that.  You say you've only been on meds for a year and a half, which would suggest you're not someone who has exhausted a lot of different things yet.  For example, how bad was your problem before you went on meds in the first place?  Are you in therapy?  Have you tried other medications?  Are you seeing a psychiatrist or a general doc -- the latter don't get a lot of training in this stuff.  Some are great, but most aren't -- frankly, most psychiatrists aren't that great at it, either, but at least it is all that they do so they do it a lot.  I think it's time for a heart to heart with your practitioner.  

[devansharora]

I would say my problem wasn't that bad before I went on meds, I had earlier watched videos of people who seem to be suffering way more than I had been
Have I tried other medications?
-Yes and no:
Few months back when I was only taking fluoxetine I was seeing a different doctor and as prescribed by her I  was taking Clomipramine 25 mg as well as fluoxetine 80 mg each day for like about 2 months
My current doctor suggested me to stop taking Clomipramine as I have had only one episode of seizure maybe like 10 years back so he suggested to be safe and instead prescribed me with the current combo
i.e Fluoxetine and Fluvoxamine

Thank you so much, I appreciate

[Paxiled]

I think you need a different doctor.  I know it's hard for me way far away from you to have a real clue about what's going on, but if your doctor is saying the things you're saying he is he has no clue about anything.  He sounds dangerous.  I have no idea why he brought up the issue of seizures in regard to clomipramine.  It is considered one of the most side effect laden antidepressant and most can't deal with it, but it's a tricyclic antidepressant, an older class than the ssris, and isn't used for seizures.  Seizures usually involve GABA, so your problem there would be with benzos.  Did your doctor think you were saying Klonopin or clonazepam?  That's a benzo that does target GABA and can cause seizures even if you've never had one if you try to stop it abruptly if you've been taking it every day.  But you wouldn't have been taking 25mg of that drug.  Clomipramine was an early drug that got FDA approval in the US to treat OCD, but again, I was on imipramine for years until it stopped working, a different tricyclic, and don't recall any connection to seizures.  Instead he's got you on two drugs that both target serotonin, which again is something some people do when everything else fails but can cause problems.  Fluoxetene isn't usually a go to drug for OCD, as it's a more stimulating ssri, but some do find it works wonders and it's very good for depression.  It's also the easiest drug to stop taking in this category, which makes it a good choice to see if it will work.  Luvox, the other drug, isn't used much here in the US because it was never marketed heavily here and has a great many contraindications with other meds.  And that thing about meditation makes less than no sense to me -- meditation is habit forming, there's no doubt about that.  When it works for you it increases energy and has a calming effect, so when you stop it can make you nervous for awhile.  But everything we do regularly is habit forming.  If you do it right, it's the opposite of focusing on things, it's learning not to focus on things.  It's hard to do and takes a lot of practice and over time it can stop working for you, in which case you can just find a different meditation.  I would definitely try a different doctor at least to get a second opinion, hopefully a psychiatrist.  If you still find after that you like your current doc, you can always keep him.  Be safe out there.  

[specialmom]

There may be an misunderstanding of what the OP is saying.  Their doctor stopped Clomipramine which seems the right course of action.  That drug is not to be used by people who have a history of seizures which the poster has even if long ago.  The doctor he sees now realized this and stopped that med which seems on track to me.

I think, to the poster, what is in question here is why you are on two SSRI's. Often, in today's psychiatric world, they do combine medications. But normally, that is two of a different class.  Each medication is slightly different but the two meds you are on work the same way so would likely compound any side effects you'd have.  Not saying though that the side effects you refer to are caused by either or the combination of the two drugs.  You seem to, overall, be tolerating them pretty well.  But it may be wise to inquire why your doctor has chosen to prescribe both of these SSRI's at the same time.  We aren't doctors and your health care provider has presumably been to medical school and practices medicine when we don't.  So, ask them what the rationale is. Is it the best choice?  Well, it doesn't sound like it but we don't know from this vantage point and that needs to be said.

I understand the dynamics of lack of the same care in India for mental health as we see in the states which means you have to work with what you've got.  But if you can learn about CBT therapy and find a provider who knows about it, that would be really beneficial to you, I'm sure.  

We're here to listen and support you as best we can.  good luck

[Paxiled]

You sent me to the research, Mom.  I was on imipramine for several years.  I just saw that it doesn't help with anxiety, but that's what I was given it for and it did just as much for my agoraphobia as Paxil did, which wasn't great but stopped me from getting new phobias.  But I also see that tricyclics are a problem for seizures, but mainly for those with epilepsy who are on anti-epileptic drugs.  They never told me that.  They also can lead to seizures when stopped, which I was also never told -- when imipramine stopped working they just told me to stop taking it.  Fortunately I got no withdrawal or other side effects.  But interestingly, I also just learned that tricyclics can also cause serotonin syndrome if combined with other serotonin affecting drugs, another thing I didn't know.  Obviously they know a lot more about them now than many years ago when I took them.  But here's what else I just learned -- ssris and snris and wellbutrin also cause seizures in about the same percentage of people as clomipramine, but that study was only on people in Taiwan with major depression.  Still, makes you wonder what else we're not being told to watch out for.  This makes me wonder -- do these drugs impact GABA in a way we don't know?  As for your statement about medical school, they don't teach this in medical school, Mom.  Pharmacology for doctors is a very limited study.  It is best studied by research scientists, not by clinical practitioners.  What they know about meds is what pharmaceutical company reps tell them or what pharmaceutical company paid docs write in textbooks.  But no clinical physician could design a drug and many of the drugs we take aren't known why they work or how they work often for years after they hit the market. If you read up on pharmacology, you can become more knowledgeable than your doctor in a few months, if you really wanted to do that.  The job of a doctor is to match symptoms to treatment, not to know complex chemistry.  Much of this information is proprietary in our system, as it's patented, so even if you wanted to know you couldn't find out everything that you might want to know.  I found this out when I had a problem with a drug and my psychiatrist dissembled.  I tried to do my own research, and went so far as to contact the manufacturer to see if they would help me out.  They refused.  They did offer to talk to my psychiatrist, but no psychiatrist I've seen has been willing to do that.  So we're not doctors, and I'm definitely not the type of person who spends hours researching complex chemistry, but over the years I've been on sites about this stuff there have been those who did enjoy doing that level of research.  None of them, of course, was a physician.  At any rate, Mom, you've enlightened me, and I thank you for it.  But it's not comforting to learn that combining tricyclics with ssris can also cause serotonin syndrome, and that pretty much all antidepressants, it appears, has a small percentage risk, about 1% it seems, of causing a seizure.  It's a small number, but it's never small if it happens to you.  Good on ya.    

[Paxiled]

By the way, another drug they recommend caution with if you have seizures is Prozac, possibly because of how long it stays in the system.  The poster is also on Prozac.

[specialmom]

In a study or in the prescribing information?

[Paxiled]

This was in several articles I discovered on Google when you posted.  I was very curious because I took meds that were similar to clomipramine and nobody ever told me about the seizure problem.  Now, I never had that problem with them, though I did have other side effects.  I stopped because the one that worked stopped working.  I stopped abruptly, because not in decades of taking these drugs did any of my psychiatrists ever warn me about withdrawal.  I had no idea it existed.  And so when you mentioned this seizure thing, I thought, whoa, something else they didn't tell me about.  It wasn't a long Google search, but it only took a short one to show studies that found that pretty much all antidepressants can cause seizures.  As with much of this stuff, it was worse for the young, and worse upon stopping the drug, but it was there.  I had no idea of this problem, I thought it was a problem associated only with GABA affecting drugs.  It's amazing what we don't know.  I did not check the prescribing information, so I don't know if it's on there or not, I tend to avoid what pharmaceutical manufacturers tell us because they only tell us what they have to, not what they know.  Mostly they tell us what the FDA orders them to.  The longer a drug is on the market, the more researchers take a look at it to see if it works, and what dangers it's presenting, as this is not known when the drug is first approved for sale.  Those of us who take new drugs are the guinea pigs.  That's how our system works, and probably how it has to work if we believe drugs are good to have around -- it would take years of large scale use studies by manufacturers to discover this stuff and it would be very expensive and really bad for business.  So the way it works is, the FDA approves a drug, then after a few years independent researchers and committees appointed by the FDA take a look and see what's happening and make changes.  Eventually this will make its way onto manufacturer materials, but not until they have to, so if you're looking for stuff the best place might not be on the prescribing materials yet.  But it might be well known among those who prescribe the drugs and study the drugs.  Those are the articles I tend to look for if I have questions, which I didn't about this issue until you posted.  Again, you've done a great service, Mom.  

[Paxiled]

But let me add, because it's important, again, it only seems to affect at most about 1% of people taking the drug.  That includes clomipramine.  But if you're one of those folks, it's no consolation to know it doesn't happen often.  

[Paxiled]

And also, it seems to be a worse problem for those who have a seizure history, especially those with epilepsy.  This is also true for clomipramine.  I was recommended that drug, but by the same quack who ruined my life by not knowing that stopping Paxil could be really really hard.  He was one of those many shrinks who think everyone has bipolar and OCD.  I had neither.  I chose not to take that drug because it has a huge amount of side effects that are very common and I was already going through hell over Paxil withdrawal.  I also chose not to take Luvox, also recommended because of the OCD thing I didn't then have, because it can't be taken along with such a large number of other drugs, including many benzos, which are used in surgery and for anxiety, so i just didn't see that as an option.  Bad shrinks are much more dangerous than the drugs.  

[specialmom]

So, you are your own advocate.  You know yourself best.  Let me ask you this though.  How is your anxiety and/or ocd and or depression since taking the medication?  That's important to evaluate because any time we take medication, there is a trade off of good with bad. If our mental health disorders are on track and we are managing well with that, then the trade off is side effects of the medication.  And you aren't even sure either of those two things are related.  Now, I'm not sure about the combination of medications you are on.  We aren't doctors and shouldn't second guess your medical team treating you.   So YOU have a conversation about why you are on both and if weaning off one or taking down the dose on two is a trial worth undertaking. If your anxiety or other mental health issues spike, you go back on.  If not, you are good to discontinue.  Don't forget the other things you can do for mental health as well such as seeing a therapist and working through things with them, finding coping strategies, triggers, etc.  Exercise plays a role in feeling our best mentally, meditation, yoga, finding peace, etc.  good luck

[devansharora]

Since taking the medication the anxiety and ocd have reduced but alongside the medications I have made significant changes to my routines and habits, so it's like i feel the medication solely isn't responsible for the improvement and maybe isn't playing a major role here
I asked my doctor if he could try and reduce the dosage but he suggested that would be dangerous as in future to treat the same amount of OCD I would need even more medication
Also as you suggested to make lifestyle changes like exercise, reading books
Since I have been making lifestyle changes, I have noticed exponential improvement.
I was doing meditation but recently my doctor suggested me to stop the practice as it could put pressure he said (idk why he said that) but I have stopped practicing meditation since.
Thank you so much for your response, I highly appreciate it.

[specialmom]

OCD is tricky and can really consume our life.  So, do work with your doctor.  I don't ever think medication with these types of disorders is 'soley' the reason for improvement, you are right. And you are really smart to be working on the 'other' things as well as that is essential.  Most have the greatest improvement with that combined approach, medication and all the 'other things'. Unfortunately, many get into a vicious cycle of discontinuing medication when they feel better and then spiraling again and then restarting it only to decide they don't need it again, and repeat the whole cycle over and over.  Situational things may mean the need for medication was temporary but often, it's not temporary and it is a life long disorder someone deals with.  So, just keep that in mind.  I do think thought that discussing what you are on is important and then it becomes up to you if you wish to follow your doctors care. If what you are doing is working, sometimes it is a good idea to not rock the boat.  However, I do think you are on an odd combination of medication.  

Hm, that's an interesting thought on meditation putting pressure on you.  What does he mean by that?  I'd ask!  I myself have a little trouble meditating in general and it makes my mind noisy. But others find great benefit from it.  I will say with OCD, cognitive behavioral therapy and exposure therapy really does wonders for many.  Are you in this kind of talk therapy with a psychologist?  I highly recommend that if not!  

Again, you are your own advocate. And you sound like a smart person for sure!  Don't stop your medication without your doctor signing off on that!  And when and if you do,  make sure to TAPER!  Reduce doses very slowly.  good luck

[devansharora]

I couldn't find a therapist yet in my area as CBT and ERP are not so common here in India
Maybe I should work towards changing my doctor
Thank you so much.