bubblebubs Posted June 19, 2014 Share Posted June 19, 2014 Hi all, I hope you are doing well. I'm at a crossroads at the moment. I've been on Prozac 10 mg/d for nearly 9 weeks now, and it has done nothing. I emailed my pdoc recently about switching back to Lexapro, and she said that I could do that, or I could try increasing my dose of Prozac. But here's the thing... I was taken off of Lexapro in mid-February (more on that later) and was put on various meds whose off-label uses included depression. AKA between mid-February to end of April, I wasn't on any antidepressants, and the meds I was taking made me angry, irritable, and tired. I am so desperate for something to work right now. My suicidal and depressive thoughts are getting worse day by day. I'm out of state at the moment so my typical support network isn't with me. I don't know how I made it this far. I talk with my friends over the internet but it's just not the same, especially when things get so bad that I purposefully ignore messages and social interaction. Here's the breakdown. Lexapro (-) Difficulty staying asleep (-) Lethargy (-) Increased appetite (-) Racing speech/thoughts (-) Distractability (+) Little/no suicidal thoughts Prozac --> Some of these are due to my depression, not the medication itself. (-) Difficulty falling asleep (-) Lethargy (-) Increased appetite and weight gain (-) Lack of motivation. I need this so, so much. I'm at a turning point in my education/career right now. (-) Suicidal thoughts. I am not doing well in this department. I could try increasing Prozac, but it takes weeks to reach steady state ("full effect") with Prozac (I've heard 3-5 or 6-8 weeks), and there is no guarantee that it is going to do anything. But I've spent so much time with this medication... Maybe it does work, but I'm not at the right dose. And if I switch away and then come back later (for some reason), this might become a destroyed chance, because I've heard SSRIs can suddenly not work after you've switched away. I could go back to Lexapro, which reaches steady state in 7-10 days, but it might not have the same effect as it had last time. I'm leaning towards Lexapro because I'm in a time crunch due to my suicidal thoughts. I'm not looking for a right or wrong answer. I want to know what YOU would do if you were me. Thank you... Link to comment Share on other sites More sharing options...
StormBeforeCalm Posted June 19, 2014 Share Posted June 19, 2014 Just my two cents, but 10 mg is an extremely low dose of Prozac. I'm on 80 and my pdoc was just talking today about putting me up to 100 or 120. I am not surprised that you're not seeing much improvement on 10. I can't know what you should do...in my case I found Prozac to be much more effective for me personally than Lexapro, although as you say it can take months of slowly upping Prozac dosages to get to an effective dose. If you are really concerned about needing an immediate solution, Lexapro would seem like a better option. Any chance you could do both? (start on Lexapro as a stop-gap while you slowly go up on Prozac, with the plan of dropping Lexapro once you are fully onto the Prozac) Link to comment Share on other sites More sharing options...
dianthus Posted June 19, 2014 Share Posted June 19, 2014 Why did you discontinue Lexapro? You're on on practically nothing as far as Prozac goes. You won't know if it will work for you until you've been on a therapeutic dose for at least a couple weeks, but Lexapro isn't that much different. None of the SSRIs work fully in 7-10 days. You may start to feel better in that time frame, but all of them take weeks to reach their full effect. In terms of what works faster, all of the SSRIs are about the same. However, you know what dose of Lexapro has worked for you in the past, so you could start at or close to that dose. Link to comment Share on other sites More sharing options...
bubblebubs Posted June 19, 2014 Author Share Posted June 19, 2014 @ StormBeforeCalm I'm pretty disappointed whem I found out that 10 mg was a very low dose. Most people titrate to 20 mg very quickly, it seems. I feel like I've wasted so much time. @ dianthus It was causing racing thoughts/speech after about a month. I mentioned it to my pdoc and I guess she took me off it to be safe. I had one major hypomanic episode last summer and (this part isn't diagnosed) ultradian cycling. And on an off-note, lamictal hasn't eliminated the cycling. Link to comment Share on other sites More sharing options...
jt07 Posted June 19, 2014 Share Posted June 19, 2014 Well, your Lamictal dose is more of an antidepressant dose than a mood-stabilizing dose. I think that you need to have a sit-down with your pdoc to determine what exactly is your diagnosis. If you are prone to cycling then perhaps antidepressants are not the best option for you, at least not without a more heavy-duty mood stabilizer on board. Link to comment Share on other sites More sharing options...
dianthus Posted June 19, 2014 Share Posted June 19, 2014 Lamictal isn't a great mood stabilizer for the high end, period, but as jt said, 100mg is low for any kind of mood stabilization effects. It's really just a starting dose for the depression end, too. You have some room to go up on that to get more antidepressant effects. If Lexapro was causing what sounds like hypomanic symptoms, it's probably not a good idea to go back on it without a mood stabilizer that actually works. Link to comment Share on other sites More sharing options...
shesellsseashells Posted June 19, 2014 Share Posted June 19, 2014 I find Lamictal to be extremely effective for stabilizing mania. For example, I was on 200 mg of Lamictal and started titrating up on Prozac. I started experiencing mania at 40 mg of Prozac. My pdoc pulled me off the Prozac, upped my Lamictal to 400 mg, and restarted the Prozac. I'm now on 60 mg of Prozac and voila, no mania. Prozac works pretty quickly for me. If your pdoc is willing to bump your dosage up you might feel the difference in less than two to three weeks. In my experience I started to feel better little by little, so it wasn't all or nothing. I have been stable for the past month or so--I feel better than I have in years. I hope you find the right med dose/combination for you to alleviate your symptoms soon. Link to comment Share on other sites More sharing options...
dianthus Posted June 20, 2014 Share Posted June 20, 2014 Yeah, it's not universal that Lamictal is a poor mood stabilizer for mania/hypomania, but that's been the general thought over the last 10 years or so from what I've seen and read. A fair number of people with bipolar disorder can't tolerate ADs at all (I'm one of them), and another group need something that controls mania better to be able to use ADs. Everyone is different, and every doctor has different strategies. I just haven't seen or read of a whole lot of evidence for Lamictal being more than a mild mood stabilizer and a good AD for people who are bipolar or can't otherwise take antidepressants. With all that said, Depakote manages depression for me, and it's a med that's more likely to cause depression in most people. But I think in my case, having adequate mood stabilization works better than treating me with ADs. As with all psych drugs, YMMV and all that. Link to comment Share on other sites More sharing options...
melissaw72 Posted June 20, 2014 Share Posted June 20, 2014 IMO I'd try increasing the prozac. I'm on 80 mg, and it really helps. If you do decide to though, it takes a few weeks to feel a difference. Link to comment Share on other sites More sharing options...
mcjimjam Posted June 24, 2014 Share Posted June 24, 2014 I would probably stick with Prozac and see what it does at a higher dose. It can go up to 80mg/day. Link to comment Share on other sites More sharing options...
dianthus Posted June 25, 2014 Share Posted June 25, 2014 I would caution everyone who has responded in this thread and especially OP that if an SSRI has caused hypomanic symptoms in the past, increasing any SSRI without proper mood stabilization in place is very risky. Honestly, one of the best meds for suicidal thoughts in people with bipolar disorder is lithium. Not only is there evidence for it in the literature, we've had countless members report that while lithium doesn't completely alleviate depression, it does lessen the severity of it. Link to comment Share on other sites More sharing options...
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