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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by edward602 on January 3, 2002, at 10:32:15
I am taking 80 mg. celexa to combat severe anxiety and depression. Previously I had been stable on 40 mg but I went off and now I am not responding as I had before. Anyone out there on a high dose of celexa. If this doesn't work, my pdoc wants to reduce the celexa to 60 and start me on effexor. Is anyone on such a combo. Thanks. Edward
Posted by CalvaryHill on January 6, 2002, at 1:15:44
In reply to 80 mg. celexa-anyone? or effexorcelexa?, posted by edward602 on January 3, 2002, at 10:32:15
You could either augment with Effexor or try some well-known augmentation strategies such as buspirone, pindolol, or T4(thyroid).
Posted by edward602 on January 6, 2002, at 12:01:51
In reply to Re: 80 mg. celexa-anyone? or effexorcelexa? » edward602, posted by CalvaryHill on January 6, 2002, at 1:15:44
> You could either augment with Effexor or try some well-known augmentation strategies such as buspirone, pindolol, or T4(thyroid).
Thanks, we are looking at 37.5 mg. of effexor in another week if the 80 mg. celexa doesn't do the trick. My pdoc augments with wellbutrin and stimulants but isn't keen on the others.
Posted by CalvaryHill on January 6, 2002, at 13:27:54
In reply to Thanks--anyone else?, posted by edward602 on January 6, 2002, at 12:01:51
You got a good doc if he's willing to prescribe stimulants (like methyphenidate, dextroamphatine, and pemoline). Some docs won't even touch the stuff.
Posted by Bekka H. on January 6, 2002, at 15:19:05
In reply to 80 mg. celexa-anyone? or effexorcelexa?, posted by edward602 on January 3, 2002, at 10:32:15
Is anyone on such a combo. Thanks. Edward
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My doctor had prescribed a Celexa + Dexedrine combination a couple of years ago. It worked well for about 10-14 days and then, the two drugs seemed to cancel each other out. Each one seemed to negate what was good about the other. By the way, I had taken each one separately at other times. The same thing happened to me when I tried to combine Zoloft and Wellbutrin. I'm not certain why this happened, but I have some ideas. I read in Joseph Glenmullen's "Prozac Backlash" that Celexa and other SSRIs lower dopamine levels by at least 50%. In other places, I've read that SSRIs deplete dopamine, but I've also read that stimulants deplete serotonin over the long run. I also read in another good book on psychopharmacology by Keltner and Folks (I'll try to provide more information on that book in another post) that one of the things that causes amphetamine tolerance is that the presynaptic receptors have greater affinity for dopamine than the post-synaptic receptors. Consequently, as dopamine levels fall, via a feedback mechanism, the dopamine will be more likely to end up on the presynaptic end than the postsynaptic end. My very crude understanding of this is that if SSRIs lower dopamine (Glenmullen cites several studies indicating that this does happen), then the little dopamine that is there will have greater affinity for the presynaptic receptor and never make it across the synapse. As I said, this is my crude understanding of the picture, and if someone wants to enlighten me on this, I'd like to hear what you have to say.
In any event, I brought all this up to say that I don't think SSRI + stimulant combos are helpful for me. I have heard from other psychopharmacologists that SSRI + mood stabilizer combos are more successful. By "mood stabilizer," I mean anti-seizure drugs that now have psychotropic uses: Lamictal, Neurontin, Depakote, Topamax. I've heard that Topamax is effective, but it impairs cognition more than the others. By the way, I took Depakote a long time ago, and it was the worst drug I've ever taken. My hair fell out, I developed bruises all over my body, and I slept all day. So much for it's "anti-depressant" properties.
Posted by jay on January 8, 2002, at 15:16:30
In reply to Thanks--anyone else?, posted by edward602 on January 6, 2002, at 12:01:51
> > You could either augment with Effexor or try some well-known augmentation strategies such as buspirone, pindolol, or T4(thyroid).
>
> Thanks, we are looking at 37.5 mg. of effexor in another week if the 80 mg. celexa doesn't do the trick. My pdoc augments with wellbutrin and stimulants but isn't keen on the others.
Hi:I am one who can't tolerate high doses of Effexor, so I am trying another SSRI with it, Zoloft. I have used Effexor and Celexa together, and have had good results. Effexor is my *basic* psych pill...I need it as a base for anything else to work. The SSRI's seem to have a bit of a positive reaction to Effexor, as I have heard many others talk about their SSRI/Effexor use.
Be careful with a trip into mania, or serotonin syndrome, though. Just watch out for any really adverse reactions. Of course, talk to your doc if you can.
Best Wishes...
Jay
This is the end of the thread.
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