Re: switching from one ssri to another

[Guest guest]

Wonder if Neurontin (good for migranes and anxiety) would be useful?

Bonnie

>

> My daughter has been taking 150 mg of zoloft for last 2 years. It helps in the

fact that she no longer scratches me and knocks things of wall and shelves.

Also, before she literally screamed and called me names all day long. It was

never ending. Now, she still calls me names and has outbursts but they last only

a minute or two but they are many, many times daily.

> My daughter is 16. She had a psychologist who told me he could treat her for

her severe ocd but over the course if five months did nothing for her. Basically

he would talk to me and my husband for 45 minutes each session and bring our

daughter in for 5-10 minutes. He told us we weren't strict enough with her. When

I told the psychologist I didn't understand why she was so mean to me because if

I was away from her any amount of time she would constantly call me and make

sure I was ok, he said " She doesn't do that because sh loves you. She needs to

make sure you're ok so she can have someone to boss around. " That was our last

session with him!

> We are in small town(1500) and the last psychologist was a 200 mile round

trip. She refuses to go to anyone else. My family doctor has been writing

prescription for her zoloft. The closest place for her to go with a qualified

psychologist would be St. Louis which is a 5 hour round trip for us. I would

certainly do this if she was willing though.

> In addition to zoloft, my daughter is on 30 mg of amitryptylline daily for

migraine prevention. She has migraines with auras. Even though medicine has cut

out migraines except for an occasional one, she still sees green spots

periodically.

> My daughter's ocd is basically unwanted thoughts. In order for the thought to

leave she repeats things to me literally 5-10 times an hour. I have homescholed

her since 6th grade so this makes for quite an exhausting and long day. She also

asks many times a day if she is a good person. My daughter used to be the most

sweet caring person you could meet. Now she is mad and unhappy all the time.

> In about the last four months she has had a few good days(certainly not

normal, but good for her). She tells me she is happy when the thoughts are gone

but she knows they will come back.

> Sorry to ramble on so. My question is in regards to switching from zoloft to

another ssri. she has an appt with our family doctor on thursday and I was

thinking about asking to have her switched to a different medicine. even though

zoloft has helped somewhat maybe another medicine would be better. I am also

going to ask his opinion about NAC due to the comments I have read here and

articles I have read on-line. I will of course ask her doctor about this(we

really trust and like our family doctor) but was wondering when switching from

one medicine to another one in the same family of medicines, how fast or slow

the weaning of one and increasing of another one should be.

> Thanks for any information.

>

> Di

>

[Guest guest]

Hi Di, we've only used one med (Celexa) but you still have a little room to go

up on the Zoloft. Have you considered that before switching?

>

> My daughter has been taking 150 mg of zoloft for last 2 years. It helps in the

fact that she no longer scratches me and knocks things of wall and shelves.

Also, before she literally screamed and called me names all day long. It was

never ending. Now, she still calls me names and has outbursts but they last only

a minute or two but they

[Guest guest]

>

> I'd be

> reluctant to switch SSRIs at this point. SSRIs often have to be gradually

tapered

> before a new one is begun. It takes a certain amount of nuance that is

> likely beyond the scope of a family doctor. You can end up with all sorts of

> instability without the expert guidance of a psychiatrist. I'd be inclined

> to increase the zoloft first before switching.

> You should be able to increase to 200 mg.

>

Fay

>

>

>

[Guest guest]

I did think about that but even though zoloft helped the episodes of being

physical towards me, the thoughts have always been way too many, Will ask doctor

about it though,

Thanks, Di

[Guest guest]

My daughter saw a psychiatrist for 5 months. Every visit I would tell her things

were still terrible and psychologist wasn't helping. She said she wouldn't go

above 150 mg on zoloft and after 5 months of no changes on meds we stopped going

to her also. The reason I was thinking of switching to another ssri was because

all the info says if one doesn't work don't give up maybe anorher one will. I

thought maybe weaning off time and building up would be quicker since they are

in the same classification of medicine. All i know what we are doing now isn't

working and I want my daughter to be happy again(rarely see a smile)

Di

To:

Sent: Monday, April 18, 2011 8:47 PM

Subject: Re: switching from one ssri to another

>

> I'd be

> reluctant to switch SSRIs at this point.  SSRIs often have to be gradually

tapered

> before a new one is begun. It takes a certain amount of nuance that is

> likely beyond the scope of a family doctor. You can end up with all sorts of

> instability without the expert guidance of a psychiatrist. I'd be inclined

> to increase the zoloft first before switching.

> You should be able to increase to 200 mg.

>

Fay

>

> 

>

[Guest guest]

Thanks, Bonnie but I hate to change her migraine medicine. We went thru 3 before

we got th amitryptylline to work. I was convinced something terrible was wrong.

We went thru opthalmologist because of the auras she was having, neurologist and

brain scans before I was finally convinced it was migraines and not something

more serious.

Di

> >

>

[Guest guest]

Ammitriptyline is a tricyclic antidepressant and because it is a an

antidepressant (like SSRI's), it can cause mood destabilization even in kids who

are not bipolar. Meurontin and Lyrica are both being prescibed for migraines

and anxiety (I believe that Lyrica is a better antianxiety drug though).

Another drug used for years and years (aka researched) for migraine prevention

is Inderal and this is supposed to treat social anxiety as well. Just something

to think about.

Bonnie

> > >

> >

>

[Guest guest]

Hi Di,

If you go into our files - click on to the left of your computer screen - you

will find a file " Treatment of OCD " , by March. In it you will find a very

comprehensive write up of the protocol for medication. You could even print if

off and take part to your family doc.

Aside from trying another ssri you can also add another low dose of something to

augment. You will see the meds they recommend. Some might actually help with

some of the behaviors. This same doc has a really good workbook for teens.

I would go cautiously if you switch. Three week intervals and small dose change

- reduce/add by equivalent amounts. Then you can see effects, and it is easiest

for the body to adapt to the change. The longer they've been on a med affects

this too, slower is best. I think that file discusses this too, it's very good,

I think you'll find everything you might want to know covered - I was just

reading it the other day myself. I find our pharmacist a really good resource

for this information also.

It can be so hard to know if the medication is doing as much as it could. We

found when our son stopped his medication for a period of time (his choice) it

was very clear that it was in fact helping. But the medication can only do so

much. For ours it was not until he started ERP that things shifted. The

depression that we were seeing by that point was because he had no life anymore,

so when he started conquering the OCD he started to get it back and everything,

including mood improved.

You might look into doing skype for ERP. Another poster mentioned Dr. Storch's

program that can be accessed by skype. You can find info on this at

www.ocfoundation.org. Skype treatment works really well for people not able to

access a psychologist in their area, which is common.

Warmly,

Barb

Canada

Son, 19, OCD, Austism Spectrum

>

> My daughter has been taking 150 mg of zoloft for last 2 years. It helps in the

fact that she no longer scratches me and knocks things of wall and shelves.

Also, before she literally screamed and called me names all day long. It was

never ending. Now, she still calls me names and has outbursts but they last only

a minute or two but they are many, many times daily.

> My daughter is 16. She had a psychologist who told me he could treat her for

her severe ocd but over the course if five months did nothing for her. Basically

he would talk to me and my husband for 45 minutes each session and bring our

daughter in for 5-10 minutes. He told us we weren't strict enough with her. When

I told the psychologist I didn't understand why she was so mean to me because if

I was away from her any amount of time she would constantly call me and make

sure I was ok, he said " She doesn't do that because sh loves you. She needs to

make sure you're ok so she can have someone to boss around. " That was our last

session with him!

> We are in small town(1500) and the last psychologist was a 200 mile round

trip. She refuses to go to anyone else. My family doctor has been writing

prescription for her zoloft. The closest place for her to go with a qualified

psychologist would be St. Louis which is a 5 hour round trip for us. I would

certainly do this if she was willing though.

> In addition to zoloft, my daughter is on 30 mg of amitryptylline daily for

migraine prevention. She has migraines with auras. Even though medicine has cut

out migraines except for an occasional one, she still sees green spots

periodically.

> My daughter's ocd is basically unwanted thoughts. In order for the thought to

leave she repeats things to me literally 5-10 times an hour. I have homescholed

her since 6th grade so this makes for quite an exhausting and long day. She also

asks many times a day if she is a good person. My daughter used to be the most

sweet caring person you could meet. Now she is mad and unhappy all the time.

> In about the last four months she has had a few good days(certainly not

normal, but good for her). She tells me she is happy when the thoughts are gone

but she knows they will come back.

> Sorry to ramble on so. My question is in regards to switching from zoloft to

another ssri. she has an appt with our family doctor on thursday and I was

thinking about asking to have her switched to a different medicine. even though

zoloft has helped somewhat maybe another medicine would be better. I am also

going to ask his opinion about NAC due to the comments I have read here and

articles I have read on-line. I will of course ask her doctor about this(we

really trust and like our family doctor) but was wondering when switching from

one medicine to another one in the same family of medicines, how fast or slow

the weaning of one and increasing of another one should be.

> Thanks for any information.

>

> Di

>

[Guest guest]

Barb,

I looked at the file. Thanks. My daughter's ocd is thought based so her

rituals arent so visible. She gets rid of her thoughts by repeating the same

thing over to me and asking for reassurance from me(not my husband or anyone

else,only me).

Di

> >

[Guest guest]

Zoloft has helped her your daughter alot. But you

still describe her as down/depressed her mood has not

improved? right? And you want to see if something works better?

I think it is complicated by her being on amitriptyline (AIM).

We have to be careful when combining medications.

Has she had any adverse reactions to medications that I can

check there DNA pathways for you. This may help eliminate

drugs that are metabolized in similar ways.

If she was not on AIM, I would suggest trying " prozac " next. Here is my

reasonining:

zoloft is metabolized by many liver enzymes by primarily C19

prozac is metabolized by many liver enzymes but primarily 2D6

lexapro is metabolized by many liver enzymes but primarily C19.

I would suggest to try next " prozac " she may metabolize it better.

Switching is going to be hard. For two reasons one is

the zoloft has to be slowly reduced. Second we have

to look at the interaction of AIM with prozac. We have

to make sure prozac doesn't increase the level of AIM

in the bloodstream. AIM can get to a toxic level, I don't

know at all the doses we have to look at this.

Pam

>

> My daughter has been taking 150 mg of zoloft for last 2 years. It helps in the

fact that she no longer scratches me and knocks things of wall and shelves.

Also, before she literally screamed and called me names all day long. It was

never ending. Now, she still calls me names and has outbursts but they last only

a minute or two but they are many, many times daily.

> My daughter is 16. She had a psychologist who told me he could treat her for

her severe ocd but over the course if five months did nothing for her. Basically

he would talk to me and my husband for 45 minutes each session and bring our

daughter in for 5-10 minutes. He told us we weren't strict enough with her. When

I told the psychologist I didn't understand why she was so mean to me because if

I was away from her any amount of time she would constantly call me and make

sure I was ok, he said " She doesn't do that because sh loves you. She needs to

make sure you're ok so she can have someone to boss around. " That was our last

session with him!

> We are in small town(1500) and the last psychologist was a 200 mile round

trip. She refuses to go to anyone else. My family doctor has been writing

prescription for her zoloft. The closest place for her to go with a qualified

psychologist would be St. Louis which is a 5 hour round trip for us. I would

certainly do this if she was willing though.

> In addition to zoloft, my daughter is on 30 mg of amitryptylline daily for

migraine prevention. She has migraines with auras. Even though medicine has cut

out migraines except for an occasional one, she still sees green spots

periodically.

> My daughter's ocd is basically unwanted thoughts. In order for the thought to

leave she repeats things to me literally 5-10 times an hour. I have homescholed

her since 6th grade so this makes for quite an exhausting and long day. She also

asks many times a day if she is a good person. My daughter used to be the most

sweet caring person you could meet. Now she is mad and unhappy all the time.

> In about the last four months she has had a few good days(certainly not

normal, but good for her). She tells me she is happy when the thoughts are gone

but she knows they will come back.

> Sorry to ramble on so. My question is in regards to switching from zoloft to

another ssri. she has an appt with our family doctor on thursday and I was

thinking about asking to have her switched to a different medicine. even though

zoloft has helped somewhat maybe another medicine would be better. I am also

going to ask his opinion about NAC due to the comments I have read here and

articles I have read on-line. I will of course ask her doctor about this(we

really trust and like our family doctor) but was wondering when switching from

one medicine to another one in the same family of medicines, how fast or slow

the weaning of one and increasing of another one should be.

> Thanks for any information.

>

> Di

>

[Guest guest]

Pam,

 

    Thanks for your reply.  Zoloft is the only ocd med my daughter has been

on. It has helped her aggressive behavior as far as physical violence towards me

but her thoughts are still extreme. She has extreme anger when the thoughts just

keep coming and I refuse to answer her questions all day long. She does get over

it alot sooner than before but she is plagued by this most of the day. The

amitryptylline for migraines was actually started before she began zoloft. She

tried a few different meds for the migraines but I didn't like the side effects.

She tried topomax and depakote. While she was on these she would keep asking me

to repeat what  I said. She said I hear what you are saying I just can't

concentrate on it. I didn't want her to have trouble focusing. Her doctor

prescribed zoloft because he said it had the least side effects and he knows how

I feel about that. I get so obsessed when I read about the side effects that it

is difficult for me

starting her on medications. Does prozac have alot more side effects than

zoloft?

 

Di

To:

Sent: Tuesday, April 19, 2011 8:29 PM

Subject: Re: Re: switching from one ssri to another

 

Zoloft has helped her your daughter alot. But you

still describe her as down/depressed her mood has not

improved? right? And you want to see if something works better?

I think it is complicated by her being on amitriptyline (AIM).

We have to be careful when combining medications.

Has she had any adverse reactions to medications that I can

check there DNA pathways for you. This may help eliminate

drugs that are metabolized in similar ways.

If she was not on AIM, I would suggest trying " prozac " next. Here is my

reasonining:

zoloft is metabolized by many liver enzymes by primarily C19

prozac is metabolized by many liver enzymes but primarily 2D6

lexapro is metabolized by many liver enzymes but primarily C19.

I would suggest to try next " prozac " she may metabolize it better.

Switching is going to be hard. For two reasons one is

the zoloft has to be slowly reduced. Second we have

to look at the interaction of AIM with prozac. We have

to make sure prozac doesn't increase the level of AIM

in the bloodstream. AIM can get to a toxic level, I don't

know at all the doses we have to look at this.

Pam

>

>

[Guest guest]

Prozac may work better, if she metabolizes it better. My daughter

had less side effects on prozac because she metabolizes it better

than zoloft. For my daughter zoloft increased agitation and

aggressiveness as the dose was increased.

The problem is this the amitripyline is a TCA, combining

a TCA and a SSRI (zoloft, prozac, lexapro)risks increasing serotonin and can

causes serotonin syndrome. True you were on zoloft and you already combined a

TCA and SSRI, but if she was a poor metabolizer of

zoloft the affect of these two may not have been great.

My caution would be to be careful mixing Tricylic's (TCA) and SSRIs.

You don't want to push her over the edge of the maximum dose.

If she metabolizes prozac better, she will do well on lower

doses. Her mood should be better at a low dose (5mg-10mg) and

her anxiety should not be worse.

The caution would be this if she metabolizes prozac better, she may

reach a maximum dose even at lower doses (due to the interaction with

TCAs). I would not go over 5mg prozac to start.

I would keep her at 5mg for at least 3-4 weeks. As she adjusts

to prozac by week 4 you should be able to assess if she is

at least improved in any ways. Her mood should improve first.

Obsessiveness is harder to treat.

If she has a good response on prozac then someone needs to

help you figure out the doses above low dose prozac (5mg).

Pediatric OCD patients often need high doses of SSRI.

10mg would still be low for treating depression. In children

they may go up to 20mg for depression and see improvement

in anxiety.

I would not go above 10mg without caution. Don't look at

the maximum pediatric doses allowed for OCD. Take it slow

with increases (only after 3-4 weeks) if there are

no increases in depression or anxiety and no side effects,

dry mouth etc (learn about serotonin syndrome and how to detect it).

Read about the cautions mixing zoloft and AM and other antidepressants with AM.

It is hard to guess if your daughter metabolizes prozac better

than zoloft. My quess would be that she would not metabolize

lexapro better than zoloft simply looking at the fact

they get metabolized by similar liver enzymes (p450 c19).

I did not want to try Abilify as our doctor suggested, I know

we reached a limit on zoloft. I wanted to trial another

SSRI and I had some data from the DNA test that prozac

was at least as good if not better. For us it turned out to

be better, less side effects.

Pam

> >

> >

>

>

>

[Guest guest]

Pam,

 

   Thank you for the information. It gives me alot to think about. I had asked

her doctor about seratonin syndrome when she began taking both of them together.

He said it wouldn't be a problem since the amitryptylline was a small dose. She

has an appt thursday with her family doctor(he is the one giving refill

prescriptions on her zoloft). I will ask him what he thinks. I know everyone

thinks a psychiatrist would be better for her meds, but due to our location and

accessibility to one, and the bad experience with last one, we rely on him. He

has other patients he also sees with ocd. We check in with him every few months

because he has blood test ran on her(not sure what all he is checking, but will

ask Thursday). I may ask about increasing zoloft. I get so paranoid(my husband

is just as bad) any time meds change or increase. My daughter was born 14 weeks

premature so it has been a very stressful 16 years. We have over protected her,

and we still can't

stop doing it. She is the best thing to happen to us even thru all of this. I

just want to see her happy and enjoying life like she most definitely deserves.

She has been thru so much(6 surgeries) in her life and it's really hard when as

a mother I can't make it all go away.

 

Di

To:

Sent: Tuesday, April 19, 2011 10:43 PM

Subject: Re: switching from one ssri to another

 

Prozac may work better, if she metabolizes it better. My daughter

had less side effects on prozac because she metabolizes it better

than zoloft. For my daughter zoloft increased agitation and

aggressiveness as the dose was increased.

The problem is this the amitripyline is a TCA, combining

a TCA and a SSRI (zoloft, prozac, lexapro)risks increasing serotonin and can

causes serotonin syndrome. True you were on zoloft and you already combined a

TCA and SSRI, but if she was a poor metabolizer of

zoloft the affect of these two may not have been great.

My caution would be to be careful mixing Tricylic's (TCA) and SSRIs.

You don't want to push her over the edge of the maximum dose.

If she metabolizes prozac better, she will do well on lower

doses. Her mood should be better at a low dose (5mg-10mg) and

her anxiety should not be worse.

The caution would be this if she metabolizes prozac better, she may

reach a maximum dose even at lower doses (due to the interaction with

TCAs). I would not go over 5mg prozac to start.

I would keep her at 5mg for at least 3-4 weeks. As she adjusts

to prozac by week 4 you should be able to assess if she is

at least improved in any ways. Her mood should improve first.

Obsessiveness is harder to treat.

If she has a good response on prozac then someone needs to

help you figure out the doses above low dose prozac (5mg).

Pediatric OCD patients often need high doses of SSRI.

10mg would still be low for treating depression. In children

they may go up to 20mg for depression and see improvement

in anxiety.

I would not go above 10mg without caution. Don't look at

the maximum pediatric doses allowed for OCD. Take it slow

with increases (only after 3-4 weeks) if there are

no increases in depression or anxiety and no side effects,

dry mouth etc (learn about serotonin syndrome and how to detect it).

Read about the cautions mixing zoloft and AM and other antidepressants with AM.

It is hard to guess if your daughter metabolizes prozac better

than zoloft. My quess would be that she would not metabolize

lexapro better than zoloft simply looking at the fact

they get metabolized by similar liver enzymes (p450 c19).

I did not want to try Abilify as our doctor suggested, I know

we reached a limit on zoloft. I wanted to trial another

SSRI and I had some data from the DNA test that prozac

was at least as good if not better. For us it turned out to

be better, less side effects.

Pam

> >

> >

>

>

>

[Guest guest]

I do know what you mean. My daughter has had a number of health

issues, she had hip surgery as a baby, she has a growth issue,

she has learning issues. By far the emotional issues have been

the most upsetting. Every medical check triggers anxiety.

Any stress in her life triggers severe anxiety.

I would focus on finding relief for the OCD.

Maybe you want to have a DNA test done. It gave me the

confidence to change my daughter's medication. And with

your daughter's (and mine) health issues you want to

find the better medication fit. The blood draw

can be done locally and shipped to CCH.

http://www.cincinnatichildrens.org/svc/alpha/g/gps/drugs.htm

My daughter's mood is happier on her medication change.

Pam

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