Effexor + Zoloft -> Prozac?

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Question:

Hello, My wife has been taking 150 mg of Effexor SR, and 200 mg of Zoloft a day, with uneven results, for the last 2 years. In part due to cost, and in part because the combination is heavy-handed, and uneven in action, including bouts of anger, it seems plausible to try switching over to longer-acting and cheaper Prozac, perhaps replacing both Zoloft and Effexor, perhaps starting by replacing one. The physician in this case is going along with whatever we decide. Does anyone have any experience with this, namely what equipotent dosages really would be, how best to make the transition, and so forth. At the moment she has been taking the same 150 mg of Effexor, one 100 mg Zoloft instead of two, and one 20 mg Prozac for about a week, but she has been feeling more down, it seems that 40 mg (and not 20 mg) of Prozac is about right to replace the missing 100 mg of Zoloft, so we will be trying that for a few days. Any thoughts and experiences would be much appreciated. Thanks, Fernand

Response:

Get another Doc, sounds like he/she doesn’t really know what to perscribe. A shrink with expeience will have a better understanding of your wifes problem. But in the end, it’s still trial and error method, cause everybody reacts differently to different meds. good luck.

Response:

Are you seeing a shrink or a MD? — John T. May Experience is what you get when you don’t get what you want.

– Hide quoted text — Show quoted text -> Hello, > My wife has been taking 150 mg of Effexor SR, and 200 mg of Zoloft a day, > with uneven results, for the last 2 years. In part due to cost, and in part > because the combination is heavy-handed, and uneven in action, including > bouts of anger, it seems plausible to try switching over to longer-acting > and cheaper Prozac, perhaps replacing both Zoloft and Effexor, perhaps > starting by replacing one. The physician in this case is going along with > whatever we decide. > Does anyone have any experience with this, namely what equipotent dosages > really would be, how best to make the transition, and so forth. At the > moment she has been taking the same 150 mg of Effexor, one 100 mg Zoloft > instead of two, and one 20 mg Prozac for about a week, but she has been > feeling more down, it seems that 40 mg (and not 20 mg) of Prozac is about > right to replace the missing 100 mg of Zoloft, so we will be trying that for > a few days. > Any thoughts and experiences would be much appreciated. > Thanks, > Fernand

Response:

- Hide quoted text — Show quoted text – >Hello, >My wife has been taking 150 mg of Effexor SR, and 200 mg of Zoloft a day, >with uneven results, for the last 2 years. In part due to cost, and in part >because the combination is heavy-handed, and uneven in action, including >bouts of anger, it seems plausible to try switching over to longer-acting >and cheaper Prozac, perhaps replacing both Zoloft and Effexor, perhaps >starting by replacing one. The physician in this case is going along with >whatever we decide. >Does anyone have any experience with this, namely what equipotent dosages >really would be, how best to make the transition, and so forth. At the >moment she has been taking the same 150 mg of Effexor, one 100 mg Zoloft >instead of two, and one 20 mg Prozac for about a week, but she has been >feeling more down, it seems that 40 mg (and not 20 mg) of Prozac is about >right to replace the missing 100 mg of Zoloft, so we will be trying that for >a few days. >Any thoughts and experiences would be much appreciated. >Thanks, >Fernand

As far as dosage, there really isn’t any conversion IME as to what equals what. It’s really based on reaction to the med which really varies from person to person. I don’t hold myself out as a medical professional, but I wonder why a doctor has 3 different antidepressants in her system at once, frankly, even two. Right now, with three different antidepressants, 2 acting on serotonin and on mainly acting on norephinephrine I don’t see how anyone would be able to sort out what antidepressant in this combo is causing which effect to happen. It’s not unheard of to be on more than one antidepressant, but to _me_, it complicates things. I assume she was put on 2 because either the Effexor wasn’t doing the job completely or just quit. If it were me, I would prefer to be switched just to one med, so if it stopped working I wouldn’t have to guess as to what is doing what. As much as we know about the brain, we have no clue as to what happens to emotions when you start dealing with med combos. It may be why you are getting the "heavy-handed, and uneven in action" you describe. In fact, if you go to the pharmacy and ask for the prescribing information attached to the bottle and can make it through all the fine print, you’ll see that agitation or anger that your wife is experience listed as a reported side effect of the medication (not common but it happens) – so it’s not implausible that one med is causing it, let alone a combo of three. It could also be the depression, but you are still just left to guesswork. I’m only speaking as someone who has been on and off of antidepressants and combinations for over 20 years, so take it for what it’s worth. Feel free to discard it. These meds can do strange things, especially in combos. While we know what goes on in our head better than the doctors and I have always played an active role in picking new meds, frankly, I would be a bit scared if my doctor told me he’d approve whatever I chose and whatever dosage I wanted and left me to do the research. I would consider going to another psychiatrist for just one or two visits while still keeping your current doctor. Explain the situation and just tell them you want a second opinion. That’s how I got the doc I have today. He saw some things, recommended some changes, and I started feeling so good I kept him. Anyway, enough blabbing. The bottom line is getting your wife to feel better, and whatever path you choose to take to successfully get there no one can complain about. My best to your wife, and you as well. Roy

Response:

Thanks, Roy, The Effexor was added when Zolotf alone became insufficient. The combination works not too badly. It would be nice if a single med worked, especially one with a longer duration of action, a more benign withdrawal, and lower cost. Hence the concept that maybe Prozac alone would be a reasonable try. But because of the (very slow) curve of Prozac, the move through a gradual substitution seems reasonable. I think we’re fortunate in having a little more control than those patients who have no say in their meds, and who consider that a blessing. With indirect acting meds like SSRIs, where the effects take time to develop, where the underlying state of the patient plays such a huge role, and where the physician has no meaningful personal experience (unlike for instance with sedatives, where the physician should clearly know from personal experience e.g. the subjective difference between a benzodiazepine and an antipsychotic), realistically we’re on our own anyway, assessing what works better, which side-effects are most annoying, etc. There are no hard and fast rules, and there are no ultimate experts or authorities. The standard info is there in the PDR, the literature and the textbooks. But many of the people in support groups have developed an invaluable body of personal experience above and beyond that, and this is what I was asking. Thanks for your input, Fernand

– Hide quoted text — Show quoted text – >Hello, >My wife has been taking 150 mg of Effexor SR, and 200 mg of Zoloft a day, >with uneven results, for the last 2 years. In part due to cost, and in part >because the combination is heavy-handed, and uneven in action, including >bouts of anger, it seems plausible to try switching over to longer-acting >and cheaper Prozac, perhaps replacing both Zoloft and Effexor, perhaps >starting by replacing one. The physician in this case is going along with >whatever we decide. >Does anyone have any experience with this, namely what equipotent dosages >really would be, how best to make the transition, and so forth. At the >moment she has been taking the same 150 mg of Effexor, one 100 mg Zoloft >instead of two, and one 20 mg Prozac for about a week, but she has been >feeling more down, it seems that 40 mg (and not 20 mg) of Prozac is about >right to replace the missing 100 mg of Zoloft, so we will be trying that for >a few days. >Any thoughts and experiences would be much appreciated. >Thanks, >Fernand

Response:

I know one thing, ZOLOFT turned me into a hair triggered bad tempered maniac, I was terrible, snappy all the time and felt that angry inside it was like frustration, My doc changed me to Prozac and within two weeks my temper was back to normal. take care

Response:

Thanks for your feedback, actually it seems that as she slowly tapers off the Zoloft and Effexor over to Prozac, my wife is showing less of that hair-trigger anger, and ALSO feeling less gloomy. It was interesting to read some studies that suggested that Prozac worked better than zoloft on people with emotional swings. It is often the case that the older meds, which are no longer on exclusive brand name patent, are discarded by physicians under sales pressure from the pharm companies, but that in fact the old original, that all the imitations were created after, is still the better one. Generic Prozac is enormously less profitable than the newer ones. Pharmacologically, unless there is a specific reason, it is fair to say that the old and inexpensive one should be tried first. I’m not suggesting that for instance an old tricyclic or MAO inhibitor be used in place of a SSRI. But within the SSRI class, the older compound, in this case Prozac, with more mileage and test results, should not be passed by just because there is a shiny new one that is better-marketed. In her case there was a brief trial of Prozac as I recall, but we know now that it’s a very very slowly acting drug, so a couple of weeks for instance is quite inadequate as a trial period. In our case, if the results continue as they have so far, it would suggest that we could have saved a lot of money and grief sooner. Fernand

– Hide quoted text — Show quoted text -> I know one thing, ZOLOFT turned me into a hair triggered bad tempered > maniac, I was terrible, snappy all the time and felt that angry inside it > was like frustration, My doc changed me to Prozac and within two weeks my > temper was back to normal. > take care > Hello, > My wife has been taking 150 mg of Effexor SR, and 200 mg of Zoloft a day, > with uneven results, for the last 2 years. In part due to cost, and in > part > because the combination is heavy-handed, and uneven in action, including > bouts of anger, it seems plausible to try switching over to longer-acting > and cheaper Prozac, perhaps replacing both Zoloft and Effexor, perhaps > starting by replacing one. The physician in this case is going along with > whatever we decide. > Does anyone have any experience with this, namely what equipotent dosages > really would be, how best to make the transition, and so forth. At the > moment she has been taking the same 150 mg of Effexor, one 100 mg Zoloft > instead of two, and one 20 mg Prozac for about a week, but she has been > feeling more down, it seems that 40 mg (and not 20 mg) of Prozac is about > right to replace the missing 100 mg of Zoloft, so we will be trying that > for > a few days. > Any thoughts and experiences would be much appreciated. > Thanks, > Fernand

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