Jump to content
CrazyBoards.org
Sign in to follow this  
300.3

Zoloft dosage question and other zoloft questions

Recommended Posts

Honestly, I've never heard of having problems of reading close up from any of these meds that aren't overly anticholinergic. (Ki's in the 1000's to 3000's nM). I had trouble reading close up when I took protriptyline (Vivactil), which is extraordinarily anticholinergic (Ki = 25 nM), and when I took the anticholinergic drug benztropine (Cogentin) for akathisia. Oddly enough, no problems with nortriptyline (Pamelor) (Ki = 37 nM—the lower the number, the higher the affinity; the higher the number, the lower the affinity). But, let me emphasize that I'm not saying that the anticholinergic mechanism of action is the only possibility for causing your eye problems.

Cymbalta is hardly anticholinergic at all... barely worth considering... (Ki = 3,000 nM) It's less anticholinergic than Prozac (Ki = 2,000 nM), but more anticholinergic than Pristiq (Ki > 10,000 nM), nefazodone (Serzone) (Ki = 11,000 nM), Effexor (Ki > 35,000 nM), trazodone (Ki > 35,000 nM) (which is used for OCD off-label), and Luvox (Ki = 240,000 nM = VERY, VERY negligibly anticholinergic, so I'm unsure as to why the door is closed on Luvox unless that's decreed by your pdoc). So unless you're extremely sensitive to anticholinergics, or if there's something other than the anticholinergic mechanism of action disturbing your eyes and causing eye pain, I'm clueless as to what it could possibly be unless it's a rare side effect/intolerance that you have to one of the other mechanisms of action of these types of medications.

Also, by saying this, I'm by no means discrediting you at all, and mean you no offense whatsoever, but do you think that you might be psychogenically manifesting some of these symptoms as a result of your OCD? Please, please don't take that personally—I'm just saying that as a possibility, because I, myself, have a tendency to do that very same thing as a result of my OCD. Of course, that's sort of an egocentric proposal on my part, so I apologize for that if it's not pertinent.

As for your glasses prescription, is it out of the question for you to perhaps get a pair of glasses strictly for use for up-close work, like computer-related work to reduce eye strain? I'm assuming you're nearsighted, so perhaps a lower prescription would be in order to reduce eyestrain when viewing a computer screen for long periods of time?

Another possibility, which is something I have done on occasion, especially when having my eyes dilated, is when wearing contacts, is get a weak pair of reading glasses (like +1.00 to +1.50, and when having my eyes dilated, up to +2.50 to +3.25... lol) and wear them on top of my contacts (-4.00 -1.25x180 both eyes as of lately), but that's assuming you can wear contacts, though, which I don't know if you're able to do.

I really hope you can get this figured out. I know how frustrating it is to have a problem and doctors not being able to figure it out, and even get frustrated with you about it.

All the best!

Share this post


Link to post
Share on other sites

I used Luvox for 15 years with incredible success. Unfortunately it pooped out on me. I'm not sure it's worth revisiting? Any med I have taken I have 98-99% "remission"

Also I would never take offense to what anyone says or thinks. I actually am gratful for all the suggestions and continued help. 

Could the ocd be manifiesting or exaggerating my eye issue? I gave it a lot of thought but no. Since I have felt so good lately I can clearly say no. Today and yesterday have been my best by far. Now my ears ?

 

I can say yes ocd exaggerates my issue with hearing because I became obsessed with tinnutus. I do hear static in my ears but I keep myself occupied.

 

So with antichorgenic effects the higher the number the less the negative effects?  What does zoloft come in at?

I'm at the beach at the moment. But will write more through out the day.

 

Believe me I'm not done with getting to the bottom of the eye pain. I never thought of contacts and usibg glasses. Thats an awesome idea.I will be going back to the Dr soon to see if I need bifocals. It defineatly "seemed" less noticeable at 75mg zoloft

 

Edited by 300.3

Share this post


Link to post
Share on other sites
1 hour ago, 300.3 said:

So with antichorgenic effects the higher the number the less the negative effects?  What does zoloft come in at?

2

Correct. (With any Ki affinity number). There are positive effect of anticholinergic effects, like prevention of extrapiramydal side effects of antipsychotics and whatnot. But the negative effects are things like dry mouth, constipation, dry eyes, possibility of glaucoma (I think? Don't quote me on that lol), etc.

Zoloft is Ki = 625 nM on antimuscarinic anticholinergic effects, so it's more anticholinergic than Lexapro (Ki = 1,240 nM), Celexa (Ki = 1,800 nM), Prozac (Ki = 2,000 nM), Cymbalta (Ki = 3,000 nM), etc.

I'm actually late getting ready for a pdoc appointment myself, else I'd write a more detailed response. Have fun at the beach! :D

Share this post


Link to post
Share on other sites

I hope your doctor appointment went well Mikrw33

How many days would it take on 100mg to see if their is a difference in eye pain between 100mg and 125mg which I'm on?

I'm beyond pissed because everyday gets better and better. This will be my second day with no xanax! :) 

My damn eyes.. I have come so far and this is so frustrating..

Edited by 300.3

Share this post


Link to post
Share on other sites

Well my vacation was awesome.. I was able to try my medication experiment unplanned lol typical fashion for me..

I dropped to 100mg zoloft for 2 days.. 

(Dr wanted to try this anyway after my vacation but I figured I should do it on vacation since I was so occupied. He wanted to take me down to 75mg but I won't be doing that.)

 

Guess what??? my eyes only slightly bother me but I don't have the pain that I have had for 3+ weeks.. 

Now what ? I can only imagine that at 80 I wouldnt feel my eyes at all. 

Now it's either try Luvox again after 5 years? 

I'm considering all the mentioned suggestions and will be talking to the doc very soon. 

Luvox (Ki = 240,000 ... I just wonder if it will work again... 

Share this post


Link to post
Share on other sites

There's a chance Luvox will work again, and if I remember correctly, you were at a relatively low dose of Luvox before you gave up on it. Luvox can be taken up to 300 mg (and probably higher I imagine if need be). If it were me in your shoes, I would be willing to give Luvox a shot again, given that I could titrate to a higher dosage more quickly (as tolerated). Either that or I would be looking for another agent to try.

Share this post


Link to post
Share on other sites

Have you tried Lexapro (escitalopram)? It's a pretty clean SSRI the the most selective of the SSRIs.

Share this post


Link to post
Share on other sites

I haven't tried Lexapro.

I really don't want to feel like shit again for another 4 weeks with transitioning to a new drug.. I dread it.. but it seems it's the only option.

So my eyes hurt on Prozac when I tried to go back up on the dosage. My eyes hurt on Zoloft. 

What are the odds the KI Affinity number is having this impact on my eyes?

I mean we know it's due to the meds  after trying 3 days with 100mg zoloft. It was awesome not to have eye pain.

 

Is there a paper I can show my Dr in regards to the KI values?

 

Also in terms of activating how would prozac compare to wellbutrin?

If my eyes don't hurt a lot at 100mg zoloft would adding wellbutrin help? 

Also does wellbutrin have a Ki rating?

Edited by 300.3

Share this post


Link to post
Share on other sites

Also what's the KI for Lexapro?

 

Sorry I found it. I see you already listed it Lexapro (Ki = 1,240

Edited by 300.3

Share this post


Link to post
Share on other sites
On 7/25/2016 at 7:55 AM, 300.3 said:

I haven't tried Lexapro.

I really don't want to feel like shit again for another 4 weeks with transitioning to a new drug.. I dread it.. but it seems it's the only option.

Not necessarily—my pdoc said generally antidepressants tend to kick in quicker if you've already been taking an antidepressant before. She explained why, but it went way over my head lol. So it could be the transitory period will be minimal at most. We could only hope so anyway. Also, I hear Lexapro is quick to act anyway.

 

On 7/25/2016 at 7:55 AM, 300.3 said:

So my eyes hurt on Prozac when I tried to go back up on the dosage. My eyes hurt on Zoloft. 

What are the odds the KI Affinity number is having this impact on my eyes?

I mean we know it's due to the meds  after trying 3 days with 100mg zoloft. It was awesome not to have eye pain.

 

Is there a paper I can show my Dr in regards to the KI values?

The Ki (affinity) to the muscarinic acetylcholine (mACh) receptors and the assumption that higher affinity is synonymous with a higher degree of blocking of those receptors being correlated with your eye pain was a theory I kind of deduced on my own. The reason being that anticholinergics (meds that block mACh receptors strongly) can cause all kinds of problems with your eyes, like pupil dilation and consequent sensitivity to light, loss of accommodation (loss of focusing ability leading to blurry vision, especially close up—cycloplegia), double-vision, increased intraocular pressure (dangerous for people with narrow-angle glaucoma, PLUS ocular hypertension is the most important risk factor for glaucoma), visual disturbances (like periodic flashes of light, periodic changes in visual field, visual snow, restricted or "tunnel vision"), and visual hallucinations (as well as auditory and other sensory hallucinations). Also, they decrease saliva, mucus, sweat, and tear production, which may lead to excessively dry eyes, which may lead to eye pain.

But these side effects would be expected in medicines with affinities of Ki < ~50-100 nM or so, and in the lower affinity meds (higher Ki #), would only be present in high doses. These side effects would be expected in high doses of anticholinergics like atropine, benztropine, and trihexyphenidyl, as well as the more anticholinergic tricyclic antidepressants like amitriptyline (Elavil), protriptyline (Vivactil), clomipramine (Anafranil), nortriptyline (Pamelor), imipramine (Tofranil), and trimipramine (Surmontil), and the SSRI paroxetine (Paxil) (probably in higher doses). High-affinity ligand binding implies that a relatively low concentration of the ligand (substance) is adequate to maximally occupy a ligand-binding site and trigger a physiological response. The lower the Ki is, the more likely there will be a reaction. Low-affinity binding (high Ki level) implies that a relatively high concentration of a ligand is required before the binding site is maximally occupied and the maximal physiological response to the ligand is achieved.

Binding affinity (Ki) is only part of the picture, though—there's also IC50 (half maximal inhibitory concentration), a quantitative measure of how much of a particular drug is needed to inhibit a given biological process (a receptor, an enzyme, etc.) by half, expressed in molar concentration (like Ki). (It is comparable to EC50 (half maximal effective concentration) in agonist drugs, also a measurement of plasma concentration of a drug required for obtaining 50% of a maximum effect in vivo, just in the opposite direction.)

So Ki is reflective of the binding affinity, whereas IC50 is more reflective of the functional strength of the antagonist, but both factor in the concentration of drug present to elicit a reaction. If the Ki of a certain receptor binding quality is much larger than the maximal plasma drug concentrations a patient is exposed to from typical dosing, then that drug is not likely to antagonize/agonize that receptor. (Which should be the case for the SSRIs and their Ki value for the mACh receptors.)

So the answer to your first question regarding the odds of the affinity (Ki) of a medicine for the mACh receptors having an impact on your eyes, maybe, but keep in mind that this is based entirely on a theory of someone who hasn't gone to medical school (yet, maybe). I'm basing my answer on the notions that, (a) it is the anticholinergic properties that are indeed responsible for your eye pain, whether it be by increased intraocular pressure, dry eyes, etc., or some other unknown mechanism, and (b) for whatever reason or another, you're extremely sensitive to anticholinergics (these affinities shouldn't be afflicting one with anticholinergic side effects, but I don't suppose it's out of the realm of possibility).

 

On 7/25/2016 at 7:55 AM, 300.3 said:

Also in terms of activating how would prozac compare to wellbutrin?

If my eyes don't hurt a lot at 100mg zoloft would adding wellbutrin help? 

Also does wellbutrin have a Ki rating?

7

Wellbutrin's affinity for the muscarinic acetylcholine receptors (mACh) is Ki = 40,000 nM (negligible to none); however, Wellbutrin is a different kind of anticholinergic—it's a nicotinic acetylcholine receptor (nACh) antagonist at various nACh receptors. I'm not nearly as familiar with the effects of these receptors and their blockade, so I can't tell you exactly what to expect by taking Wellbutrin. I just figured it was worth noting. I don't know any affinities of any of the receptors for the nicotinic receptors.

It's hard to say whether Wellbutrin would help. Sometimes it can exacerbate people's anxiety and make them worse, making them feel more agitated, but for some (like me) it makes them feel more relaxed and calm. YMMV.

 

21 hours ago, 300.3 said:

Also what's the KI for Lexapro?

Sorry I found it. I see you already listed it Lexapro (Ki = 1,240

2

So your eyes hurt on Prozac, now they hurt on Zoloft...

mACh affinities: (Ki = nM)

  1. Zoloft (625 nM)
  2. Lexapro (1,240 nM)
  3. Prozac (2,000 nM)
  4. Luvox (240,000 nM)

As anticholinergics: Zoloft > Lexapro > Prozac > Luvox. So Zoloft is the "most anticholinergic" med you've taken so far, and Lexapro is more anticholinergic than Prozac, and Prozac made your eyes hurt when you went up on the dosage (higher dosage must have brought out the anticholinergic side effects?) My guess is that Lexapro might also make your eyes hurt, but you can always give it a shot. In fact, why not give it a shot? See if we can disprove this whole anticholinergic nonsense I've conjured up... lol. Otherwise, if you aren't feeling that adventurous and would rather try something that, if we're right about this anticholinergic <—> eye pain thing, it'd be best to choose an antidepressant with an affinity greater than 2,000 nM, preferably as high a number as possible...

  1. Luvox (240,000 nM) (you've tried it before but only at lower doses, it may be worth a retry at higher doses, say up to its max of 300 mg)
  2. (Wellbutrin (40,000 nM), but may not be the best for your anxiety/OCD)
  3. Trazodone (> 35,000 nM) (very sedating, especially at therapeutic levels, but they have an extended release version, Oleptro, that you take once at night, that you could ask about. Not sure if it's generic yet or not, and I don't think there's a coupon for it if it isn't generic yet...)
  4. Effexor XR (> 35,000 nM) (may be stimulating, but may be good for anxiety, has a nasty withdrawal syndrome if you ever switch or discontinue, so beware)
  5. Pristiq (likely > 35,000 nM) (may also be stimulating as it's the synthetic active metabolite of Effexor, not associated as much with withdrawal syndrome AFAIK, only comes in two doses, 50 mg, and 100 mg, 50 mg being "THE" dosage, no evidence that 100 mg is more effective, not approved for anxiety but might help anyway)
  6. Nefazodone (Serzone) (11,000 nM) (said to be good for anxiety, caution about liver toxicity)
  7. Fetzima (likely > 10,000 nM) (may be quite stimulating, may actually worsen anxiety, or help it, just throwing it on the table)
  8. Cymbalta (3,000 nM) (may be stimulating or sedating, may have a withdrawal syndrome like Effexor but not nearly as bad)

 

Share this post


Link to post
Share on other sites

Ok so only few questions ..(for now ;) since I'm at work.

1. What if any studies have been done on statistics on if in the past a drug has "pooped out" going back to it 5-6 years later it could work?

I have heard it could not work as well or with side effects one never initially had. 

My current  doctor did say my old Dr should have tried increasing luvox before abandoning  it .. but that's where under the bridge.

2. ssri meds are sometimes used together off label. My question is why quit zoloft if I have no eye pain at 100mg. Can another drug be used to augment ? That's what made me think of wellbutrin because they "supposedly" work synergisticlly. Also perhaps another ssri added to pick up the slack? If Sert occupancy is low which it is on most drugs . What would the addition do if it was another ssri. Also this is taking into account I'm on such low dosages and seretonine syndrome is rare. My docter does mix ssri's.

3. what values determine if a drug is activating as I have read wellbutrin can be? And if so how can one compare it to prozac which is considered activating, and did cause me to have panic attacks and increased anxiety that did eventually abate.

4 how at risk does one become of being med resistant with trying different drugs? I always stick it out as you guys can see. But I would hate to jump to lexapro which my dr suggested and have the eye issue and then try luvox.

5 is there paperwork links to studys so I can go over this with my dr?

6 is there a formula to calculate ki and IC50? 

For example I try lexapro at 30mg and tried zoloft at 125mg

If it's not the antichorgenic effects could it be the same receptors/pathway that both zoloft and prozac use causing the issue? 

 

 

 

 

 

Edited by 300.3

Share this post


Link to post
Share on other sites

My personal opinion would be to forget the Wellbutrin. It is not a serotonergic drug and the increased anxiety would exacerbate your OCD.

Share this post


Link to post
Share on other sites
11 hours ago, 300.3 said:

Ok so only few questions ..(for now ;) since I'm at work.

1. What if any studies have been done on statistics on if in the past a drug has "pooped out" going back to it 5-6 years later it could work?

I have heard it could not work as well or with side effects one never initially had. 

My current  doctor did say my old Dr should have tried increasing luvox before abandoning  it .. but that's where under the bridge.

2. ssri meds are sometimes used together off label. My question is why quit zoloft if I have no eye pain at 100mg. Can another drug be used to augment ? That's what made me think of wellbutrin because they "supposedly" work synergisticlly. Also perhaps another ssri added to pick up the slack? If Sert occupancy is low which it is on most drugs . What would the addition do if it was another ssri. Also this is taking into account I'm on such low dosages and seretonine syndrome is rare. My docter does mix ssri's.

3. what values determine if a drug is activating as I have read wellbutrin can be? And if so how can one compare it to prozac which is considered activating, and did cause me to have panic attacks and increased anxiety that did eventually abate.

4 how at risk does one become of being med resistant with trying different drugs? I always stick it out as you guys can see. But I would hate to jump to lexapro which my dr suggested and have the eye issue and then try luvox.

5 is there paperwork links to studys so I can go over this with my dr?

6 is there a formula to calculate ki and IC50? 

For example I try lexapro at 30mg and tried zoloft at 12

If it's not the antichorgenic effects could it be the same receptors/pathway that both zoloft and prozac use causing the issue?

 
  1. Not sure, but I'll see if I can dig some up.
  2. It seems to me that combining SSRIs is redundant, both cost-wise and medically. Why put two meds at low doses in your body when you could just take a higher dose of one med that actually works and doesn't cause side effects? Wellbutrin isn't a SSRI, it's a NDRI (norepinephrine-dopamine reuptake inhibitor), and as such, as jt07 said, it's not serotonergic and likely wouldn't benefit OCD. You are right in that it augments SSRIs and works synergistically, but it does so by effectively causing trimonoaminergic reuptake inhibition (serotonin from the SSRI + norepinephrine and dopamine from the Wellbutrin) causing a stronger antidepressant response. It just doesn't work that way for OCD. For OCD, an augmentative agent would be something that antagonizes glutamate activity in the brain (I think I mentioned some agents earlier in a previous post. You said I think that your pdoc mentioned riluzole, that would actually not be a bad idea to try, either in monotherapy or as an adjunct. I hear it's extremely effective for both OCD and depression. I wish my pdoc would prescribe it for me (I asked...)).
  3. There are many properties that can make a med stimulating/activating, but in the case of Wellbutrin, it's the norepinephrine and dopamine reuptake inhibition, causing increases in the amount of norepinephrine and dopamine in the nerve synapses. Prozac is activating due to its antagonism of the serotonin receptor 5-HT2C, which in turn disinhibits dopamine and norepinephrine release and thereby has a stimulatory effect. In much higher doses, it exhibits norepinephrine reuptake inhibition too, which is also stimulating. As to how they compare in how activating they are, that's more of a subjective experience (everyone's different, so one may say one is more stimulating than the other, and another may say the opposite). It's dose-dependant for both medicines. Sounds like your Prozac dose was escalated a little too much too quickly.
  4. I honestly haven't read much about this, so hopefully someone who knows more about this can step in and answer this for you.
  5. Studies for what specifically?
  6. IC50 and Ki are determined with special lab tests. There are formulas to calculate Ki from IC50, but there are other variables required that you may not have. There are, however, tables that have Ki values at various receptors for various medicines.
    https://en.wikipedia.org/wiki/Pharmacology_of_antidepressants#Receptor_affinity is one source. If you look elsewhere, you may notice the values are different, so you have to just go with what is most consistent.
    http://kidbdev.med.unc.edu/databases/pdsp.php is another source. Specify what medicine you're looking up by selecting it under "test ligand," and I usually select "human" under "species" so I know the Ki values were determined in human brain receptors (instead of rats, etc.)

>> For example I try lexapro at 30mg and tried zoloft at 12
I'm not following you. Are you asking about dosage equivalents?

>> If it's not the anticholinergic effects could it be the same receptors/pathway that both zoloft and prozac use causing the issue?
Possibly, but what it could be is a mystery to me. Your pdoc would be the one to discuss that with.

Share this post


Link to post
Share on other sites

As you guys can see I'm pretty frustrated.. the last time I spoke with my doc he mentioned a few meds and Lexapro continually was mentioned. No med is of the table and I'm considering anything. 

Last week I made an appointment with my doctor so I see him on Monday. I'm sad because while in Florida for 8 days everything was lifting and was able to wake up in the morning lay in bed and not think..

My eyes were in severe pain and would go to bed early or take naps during the day so my eyes could rest.

But it felt so amazing to feel like I was coming out of this ocd/depression!!!

After much reading and speaking to another doctor who is a close friend wellbutrin most likely won't be a good fit as most have mentioned.

My frustration comes from the fact if I could have only made it to 125mg and stayed I would be still getting much better daily. 

I know things don't work like my outlandish idea of somehow making up for  the lost 25mg of zoloft in another form.

You guys can see how close I am.. the 25mg thats causing my eye issue. The 25mg that was making me feel much better on a daily basis.

Right now I'm at 118.5 and my eyes are sore but I can deal with them.. they aren't in pain like they were at 125mg..

My first doc in the beginning said try prozac brand name and never did because of cost.

For the heck of it I tried calling a pharmacy to see if they make brand name luvox and they don't

Also I'm a bit hesitant on the lexapro because the first eye dr I spoke with said he sees lexapro causing most of the eye issues he sees . I know everyone is different ..

 

Sorry for the ramblings.

 

 

 

Edited by 300.3

Share this post


Link to post
Share on other sites

Vacations are like that. I always get hit with rebound depression after a vacation. I'm sorry you are frustrated though.

Lexapro can cause blurriness of vision and pupil dilation and trouble focusing ... at first. After you get used to it, that all clears up for most people. I have never heard of Lexapro causing eye pain. Of course, I've never heard of Zoloft causing eye pain either.

I would put the Luvox on the back burner if I were you and try everything else first because you have no guarantee it will work again. Of course, you have no guarantee that another med will work without eye pain either. So it's kind of a six of one/half dozen of the other type situation.

Try not to let yourself get too frustrated. All you have to do is to try another med. I would recommend that you talk to your doctor about doing a faster titration than you did with the Zoloft. A very, very slow titration is likely just wasting time until you see if the med is going to work or not. No reason to be scared. If one med doesn't work, you put it back and try another until you find one that fits you.

Share this post


Link to post
Share on other sites

I can only hope if I try Lexapro I don't need such a high dose. I continually read how strong it is and superior in many ways over other ssri's. If it is in fact that strong if I did need a low dose maybe it would exert less  anticholinergic effect.  If in fact the theory of this causing the issue is correct.

Hopefully if and when I stop the zoloft the ear noise that I hear goes away. I never complain about it but it's annoying.

Does anyone have any links to effectiveness in OCD?

 

Jt

it was more then rebound.. the cloud of depression was lifting until the pain in my eyes became so bad I went down.

Last week would have made the 3-4 week mark on a given dosage of 125mg

I'm not sure what a bigger gamble is. Trying Luvox again or try Lexapro.....

 

Edited by 300.3

Share this post


Link to post
Share on other sites

Lexapro at least has the advantage of minimal/no titration... usually, you start at a therapeutic dose of 10 mg, and if need be, go up to 20 mg, which is usually considered the maximum, but people go up to 40 mg sometimes. You can start with 5 mg if you want, but usually, you don't need to. Anecdotally, I've read people with OCD needing the higher doses (30-40 mg) and not having much success with it after all.

Celexa actually has an indication for OCD, but I'm not much of a fan of Celexa personally (never taken it, but the R-enantiomer cancels out the actions of the S-enantiomer supposedly, which is why low doses like 10 mg are useless, and why they most often start you at 20 mg and move you up to 40 mg as quickly as possible, that and it has cardiovascular safety issues).

Don't forget about Cymbalta and Effexor (wouldn't recommend Effexor due to the withdrawal effects, they're mighty hellish). They can be helpful with OCD too and are minimally anticholinergic (well, Cymbalta is slightly anticholinergic, but at the blood concentrations that will be in your system, the affinity isn't high enough for the mACh receptors to have an appreciable effect).

One thing I haven't mentioned, this is purely my own experience, so take it or leave it, but the non-stimulant ADHD drug Strattera I noticed actually helped me with my OCD. It more so helped me with my impulsivity (probably more so part of my ADHD), but it also helped me not to act on my compulsions with my OCD, and consequently lessened my anxiety about my obsessions (like I wasn't worried I was going to act on them compulsively without my control as much). I was only on 40 mg, but did experiment a little and go up to 80 mg for a little bit... It was interesting. I was taking it as an adjunct to Zoloft to create triple reuptake inhibition (serotonin and dopamine from Zoloft, norepinephrine from Strattera) since I can't take Wellbutrin anymore (suddenly started causing seizures and strange tremors one day).

Also, don't forget your pdoc offered to prescribe you riluzole... (so jealous...) That's an immense help for people with OCD and treatment-resistant depression.

I'm sorry, but my opinion differs from jt07, I think trying Lexapro is a bigger gamble than trying Luvox, especially since your eye doctor said he sees Lexapro causing more eye problems, and because higher doses tend to be needed for OCD in Lexapro (like supratherapeutic doses, 30-40 mg). As long as you could be titrated on Luvox at a more rapid pace, and be guaranteed to be titrated to a dose higher than the original one you were on (like 200-300 mg?), you'd be able to tell if it would work for you again, perhaps even better at a higher dose than before. They make an extended release version of Luvox (Luvox CR) that comes in 100 mg and 150 mg capsules, and it's taken at bedtime. It's started 100 mg at bedtime and can be increased by 50 mg per week (not sure how you'd get the 250 mg dose since they're capsules... lol I guess you'd skip from 200 mg to 300 mg). Perhaps that might work better for you? That's my two cents, for what it's worth.

Share this post


Link to post
Share on other sites
21 hours ago, 300.3 said:

I can only hope if I try Lexapro I don't need such a high dose. I continually read how strong it is and superior in many ways over other ssri's. If it is in fact that strong if I did need a low dose maybe it would exert less  anticholinergic effect.  If in fact the theory of this causing the issue is correct.

Hopefully if and when I stop the zoloft the ear noise that I hear goes away. I never complain about it but it's annoying.

Does anyone have any links to effectiveness in OCD?

 

Jt

it was more then rebound.. the cloud of depression was lifting until the pain in my eyes became so bad I went down.

Last week would have made the 3-4 week mark on a given dosage of 125mg

I'm not sure what a bigger gamble is. Trying Luvox again or try Lexapro.....

 

Honestly, at this point in time, I would let my doctor decide which is best because for you or me, it's just going to be a coin toss.

I wouldn't say that Lexapro is stronger than other SSRIs, just more selective.

Some links for you:

http://www.ncbi.nlm.nih.gov/pubmed/19730388

http://www.ncbi.nlm.nih.gov/pubmed/18922243

http://www.ncbi.nlm.nih.gov/pubmed/18693600

http://www.ncbi.nlm.nih.gov/pubmed/18567973

http://www.ncbi.nlm.nih.gov/pubmed/18345966

http://www.ncbi.nlm.nih.gov/pubmed/18090508

And finally, here is an interesting link that might suggest clomipramine could be augmented with an SSRI. I'm wondering whether maybe  the other way is true too, i.e. that low-dose clomipramine might be able to augment Zoloft:

http://www.ncbi.nlm.nih.gov/pubmed/19037176

Share this post


Link to post
Share on other sites

Thanks guys for all the help and information. Also I will discuss the options with my doctor and go from there. I would never make a change without his knowledge.  I'm happy to at least know that it is the medication causing the eye pain

I have no doubt Lexapro would work. Ive  been reading none stop about how it also doesn't have a bad side-effect profile.

 All the meds I have taken worked. Including Zoloft. I'm blessed or lucky :) now I need a med/s that doesn't bother my eyes. 

My doctor offered a lot of options as you guys know.  

 

 

 

 

 

 

Edited by 300.3

Share this post


Link to post
Share on other sites

If my doctor gave me a list of options and I couldn't decide which is best, I'd say to the doctor, "What do you think I should do, doctor?" That's why he gets paid the big bucks. He is supposed to know this stuff and not put it on you to decide, though I do know that he is trying to work with you and that is generally good.

I don't think there is a right or wrong answer here. The central question is would med X cause your eyes to hurt and I don't think anyone can answer that question without your trying the med. Even with the Luvox, you don't know 100% that it too won't cause you eye pain at a higher dose. So rather than fretting about this, I'd ask my doctor what is best.

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Sign in to follow this  

×
×
  • Create New...