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How should doctors dose antidepressants?
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Thomas Schwartz, MD posted:
You can also advocate for yourself once you know this.
1- start at a dose lower than that usually advocated by the FDA. Do this for a few days to get your body and brain used to it in order to hopefully lower your side effect risks
2- increase and take the lowest FDA dose for 4-6 weeks
3- if you are not better increase to the middle dose for 4-6 weeks
4- if you are not better increase to the highest FDA dose for 4-6 weeks.

if you and your doctor accomplish this then you have had a 'full trial' of the antidepressant. If the full trial has failed, ask your doctor for another similar trial ideally of an antidepressant to works on a different set of neurotransmitters. Do not stay on the same low dosed antidepressant for several months if it is not helping....
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aysamynr responded:
I have been using anti-depressants for about 20 years, on and off. I have been on Citalopram 20 mg. for about 2 months now and nothing is happening, except increased depression and OCD symptoms. Should I ask my Dr. to increase the dosage, or should I try something else.

I was on Cymbalta last year, but had terrible headache/stomach pain/vision problems when I went off of it, even though it was gradually. It has taken me almost a year to have the nerve to try a different anti-depressant again. I am terrified of getting off of another anti-depressent. I always take my medication as prescribed, but they never seem to work for me. My doctor insists I should be on them. Help!
 
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multitasker replied to aysamynr's response:
Are you seeing a psychotherapist to help you with the depression and OCD symptoms?
 
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ria65 replied to aysamynr's response:
I know this is hard to hear, but it often takes a trial of 2 or 3 medications to find the one that works for you. I've been on anti-depressants for about 15 years. When I find something that works, I stick with it and it will usually work for about 1-2 years. Then my body develops a tolerance and I need to try something new. I know it's hard to hear, but i takes about 4-6 weeks of taking a medication before really knowing if it works for you. You may also need a mood stabilizer in addition to an anti-depressant. Medications like Abilify or Lamictal are given with anti-depressants. For the very best possible outcome, it is good to see a psychiatrist for medication, and also a therapist to work out lingering issues. Both together will should help you manage your depression and OCD.
 
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jessicagrace89 replied to ria65's response:
I am on 150mg of sertraline (generic brand of zoloft)...is this an excessive amount? if i miss one dose, i tend to get violently ill...does this mean my body is dependant on the drugs? how can i get off the drugs and no longer be depressed???
 
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ria65 replied to jessicagrace89's response:
150mg of Sertraline is not too high. It can be dosed as high as 200 mg. The question is whether if helps you manage your depression. Missing one dose shouldn't make you violently ill, but you should never just quit taking an anti-depressant, you should taper down to lower dosages first. Some people have symptoms when they start to taper off a medication. I never did. But I am always starting up on a new medication at the same time.

There are many studies that show that going on and off medication can make depressive episodes much worse to get over. Unfortunately, once a person has has one depressive episode, they are very likely to have more. It is rare that a person just has one episode, is treated with meds, goes off the meds,, and never has another depressive episode. If you are clinically depressed, you will do much better finding a medication and dose that works for you, and staying on it even after you feel better. For some people, like me, I can usually stay on a med for about 1-2 years and then my body becomes tolerant of the drug and I then need to find a new medication. Over the last 20 years I've been on almost every medication there is for depression and now I'm starting over with Paxil.

You ask how can you get off the drugs and no longer be depressed? I can think of only one way. You make sure you eat a great diet, get all the vitamins and minerals you need, always get the right amount of sleep, exercise regularly, and avoid stress. All of those things can help keep you from getting depressed, but they are no guarantee. Some people will get depressed no matter how well they take care of their body. I'm one of them, you may be too. Good Luck!
 
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An_202969 replied to jessicagrace89's response:
I started taking sertraline (100mg) in order to get off of zanax about 16 weeks ago. I've been off the zanax now for about 8 weeks, and I recently stopped taking the sertraline about 3 weeks ago. I'm feeling fine, a little jittery now and then but not so much as to start taking zoloft again. If I was going to have any major withdrawal systems, would it have happened already.
 
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mocash1 responded:
just now Anon_15911 replied to jessicagrace89 's response: I started taking sertraline (100mg) in order to get off of zanax about 16 weeks ago. I've been off the zanax now for about 8 weeks, and I recently stopped taking the sertraline about 3 weeks ago. I'm feeling fine, a little jittery now and then but not so much as to start taking zoloft again. If I was going to have any major withdrawal systems, would it have happened already. Thanks for your Reply!
 
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RitzQ responded:
My son was just recently prescribed Lexapro and Abilify because he attempted to take his life a month ago. He never really showed symptons of suicide prior to this or perhaps I was just lying to myself and just didn't see it. The reason I'm concerned with respect to the medicaitions is that he stopped taking the abilify cause he said it made him way too sleepy and uncomfortable, he claims to feel better without it and please understand all tthis has just happened in the past month. Should I be wooried? I have read up on the net everything I can and tried to advise him but I really don;t know what to say to him. By the way he is only 24 yrs. young and I am so scared for him. Any suggestions?
 
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Beckyblueiz24 responded:
was just diagnosed maybe a month or two ago with depression anxiety and post traumatic stress disorder, The woman who i have been waiting for to do my meds was just replaced and i have to wait (who knows how long) before i get to finally see her! What kind of medications will they put me on?
 
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sabajma responded:
I am on 5 mg dosage of Lexapro, had initial side effects for about 2-1/2 weeks and then subsided. Doctor wanted me to increase to 10 mg but I feel ok now and told her no. I'm trying to take 'less' than 'more.' one step at a time. thanks for the advice on dosages...it helped me.
 
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moonie91 replied to Beckyblueiz24's response:
Many drugs used to treat anxiety are also anti-depressants. I have GAD and Anxiety Disorder with Panic attacks and mild-agoraphobia. I've taken Xanax, Paxil and Buspar. Paxil and Zoloft are commenly prescribed for anxiety disorders. Buspar is for anxiety and it is similar in action to Xanax without dependancy. Buspar acts on the neurotransmitter Serontonin and Xanax works on G.A.B.A. Depending on how high or intense your anxiety level is your doc may prescribe Xanax to calm you while your other meds have a chance to work. MAOI's are rarely if ever prescribed anymore due to severe side effects. I would look up on the web: Paxil, Zoloft, Xanax, Buspar. It will tell you what they are prescribed for, side effects and all that kind of stuff. Other antidepressents are Lexapro, Prozac, Cymbalta. I have never taken any of these for my anxiety. It takes up to six to eight weeks sometimes for these meds to work so don't become discouraged if you don't find relief right away. The best treatment possible is to use meds in conjuction with psychologial counseling and in some cases a therapy that involves exposure to the things that cause anxiety. It's called Cognitive behavioral therapy. Also...if your are having a lot of anxiety cut back on any caffeine, aspartme, and sugar you are consuming these substances can increase anxiety. Hope that helps...sorry it was so long!
 
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moonie91 replied to RitzQ's response:
He shouldn't stop taking any meds without first talking to his doc. This can be dangerous. If the Abilify is causing side effects he should be slowly cut back and not quit cold turkey. Is your son bi-polar? I've heard some talk about using Lexapro with Lithium as apposed to Abilify. Might be something to ask the doc about. Hope that helps.
 
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mattheww50 replied to RitzQ's response:
Abilify is an unusual drug in that it is a partial dopamine agonist. At low doses it boosts dopamine levels, and at higher doses it is a dopamine antagonist. The common belief is that more is usually better then less.

Abilify doesn't work that way. Less is often better than more where depression and Abilify are involved.

The recommended Abilify dosing for depression is probably too high for many patients. At the correct dose, it should boost dopamine, which can be quite 'activating' (as opposed to making the patient drowsy).

Also serum half life with Abilify is VERY LONG. So changes in dose take a long time to reach steady state.

So if your son was given 15 or 10mg, and it made him sleepy and uncomfortable, 2 or 5mg may work much better for him than 10 or 15mg. You should discuss this with a psychiatrist and see whether a trial at lower does might be useful.
 
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LBunch11 replied to Beckyblueiz24's response:
Hi Beckyblueiz24,I have been dealing with depression and PSTD for about 2years. You should try Cymbalt 60mg and resperidone 2.5mg. It took about 4weeks to help and it has worked wonders for me. LiscoB.


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