Question:

I have another question about peak flows. I was diagnosed 14 months ago and, despite many different meds, my peak flows have not really budged. And, based on the charts, I’m 100 below where I should be. So how reliable are they? And why aren’t my meds working? (BTW — Just given another new med today!) The charts are only a rough approximation based on height, sex, and age. Other variables include race, chest size, etc. Your Peak Flow is what is measured when asthma is under control, after using a bronchodilator at mid-day. Your peak flow is not supposed to increase; the asthma drugs keep your lung function in the Green Zone (80% of PB).

Sorry, I was referring to Personal Best peak flow here. Personel Best numbers are not expected to increase, but if your typical peak flow is <80% of personal best, it indicates asthma is not controlled. To determine Personal Best peak flow, it may be necessary to give a burst dose of prednisone to quickly control the asthma. – Hide quoted text — Show quoted text – If asthma meds are not working, it raises doubts about the asthma diagnosis. Asthma is diagnosed using lung function tests. Lung function is measured before and after giving an inhaled bronchodilator like albuterol; a 12% improvement tends to confirm an asthma diagnosis. In difficult cases, a 2nd lung test may be given, called a methacholine challenge. Asthma is a reversible disease. If lung function is not reversible, it raises suspicions of COPD. Ellis

Response:

I have had asthma for 15 years and was told about a month ago that my asthma is not under control at all.  I was on Beclovent but now I take Serevent, Flovent, and Salbutamol. I now only use Ventolin about three times a week instead of 3-4 times a day like before. I monitor my peak flows everyday and have noticed that even when I feel that I am having an asthma attack (short of breath, tight chest, coughing) my peak flows usually don’t drop very much and sometimes don’t drop at all.  Are peak flows really a good way to tell how much distress you are in?  Does it work better for some people and not for others? My doctor always determines the severity of my attacks by having me blow once on the peak flow meter.  The problem is that sometimes my peak flows are good but I’m still not feeling great.  I have read a lot on asthma but I still have no answers to this (forgot to ask my doctor that last time I was in).   Sometimes I have wondered if it is all in my head when my peak flows are good and I’m still having problems breathing, but I know that that is ridiculous.  Any insights on this would be greatly appreciated. Meghan (new to this list) Before you buy.

Response:

I have another question about peak flows. I was diagnosed 14 months ago and, despite many different meds, my peak flows have not really budged. And, based on the charts, I’m 100 below where I should be. So how reliable are they? And why aren’t my meds working? (BTW — Just given another new med today!)

Response:

not everyone fits into the charts.  The charts are based upon an average individual with average non-disease oriented lungs.  The charts are averaged based upon size and age however. therefore, your norm will be unique to you.  If it is not budging upward then you may well be at your personal best and all future measurements will be based upon that number. Scooby RCP, EMT-P Perinatal-Pediatric Respiratory Specialist This mail is a natural product.  The slight variations in spelling and grammar enhance its individual character and beauty and in no way are to be considered flaws or defects.

Response:

I have another question about peak flows. I was diagnosed 14 months ago and, despite many different meds, my peak flows have not really budged. And, based on the charts, I’m 100 below where I should be. So how reliable are they? And why aren’t my meds working? (BTW — Just given another new med today!)

The charts are only a rough approximation based on height, sex, and age. Other variables include race, chest size, etc. Your Peak Flow is what is measured when asthma is under control, after using a bronchodilator at mid-day. Your peak flow is not supposed to increase; the asthma drugs keep your lung function in the Green Zone (80% of PB). If asthma meds are not working, it raises doubts about the asthma diagnosis. Asthma is diagnosed using lung function tests. Lung function is measured before and after giving an inhaled bronchodilator like albuterol; a 12% improvement tends to confirm an asthma diagnosis. In difficult cases, a 2nd lung test may be given, called a methacholine challenge. Asthma is a reversible disease. If lung function is not reversible, it raises suspicions of COPD. Ellis

Response:

Question:

- Hide quoted text — Show quoted text -Has anyone here noticed that their asthma symptoms have changed since being on Flovent.  I am talking about when you are actually having some asthma trouble.  I notice that my attacks come on slower now and less frequent with Flovent – and I also notice that the symptoms tend to be different.  Before Flovent my asthma symptoms always started with a tightness in my upperchest and a definite Wheezing.  Now I find they seem to start lower down in the chest – feels likea tightness in the lower back actually – and I don’t get wheezing as much as I just feel short of breath.  I wondered if I was along in this sensation.

If it’s helping, I don’t see it. I’ve had three bouts of bronchitis since Sept. Helen

Response:

CarolR hit it right on the head. After being on Flovent for about a year, my symptoms changed from having chest tightness to a feeling only my small airways were slowly closing on me.  Atrovent, by the way, takes care of "that" feeling much better then Albuterol….

Response:

Has anyone here noticed that their asthma symptoms have changed since being on Flovent.  I am talking about when you are actually having some asthma trouble.  I notice that my attacks come on slower now and less frequent with Flovent – and I also notice that the symptoms tend to be different.  Before Flovent my asthma symptoms always started with a tightness in my upperchest and a definite Wheezing.  Now I find they seem to start lower down in the chest – feels likea tightness in the lower back actually – and I don’t get wheezing as much as I just feel short of breath.  I wondered if I was along in this sensation.

I get the tightness and feel short of breath also.  I rarely ever wheeze anymore.  I don’t get the typical asthma attacks.  I almost feel like only my small bronchioles are affected now rather than the large bronchus.  Kinda weird . CarolR

Response:

Has anyone here noticed that their asthma symptoms have changed since being on Flovent.  I am talking about when you are actually having some asthma trouble.  I notice that my attacks come on slower now and less frequent with Flovent – and I also notice that the symptoms tend to be different.  Before Flovent my asthma symptoms always started with a tightness in my upperchest and a definite Wheezing.  Now I find they seem to start lower down in the chest – feels likea tightness in the lower back actually – and I don’t get wheezing as much as I just feel short of breath.  I wondered if I was along in this sensation.

Response:

Question:

Hi all, For those of you who use a spacer when taking oral sprays (as I do) do you take your spacer with you when you travel and if so, how do you pack it/take it with you? Mind’s rather bulky. I own what my family refers to as ‘the suitcase’.  It’s a BIG purse [actually an athletic bag].  Just inside the legal limit for carry-on for the airlines.  Amazing how much stuff you can get in there.  :) Chris Owens

I’m laughing! The last time the whole family flew somewhere, I carried all meds in a huge athletic bag. When a security guard stopped me to look through the bag, I just kinda threw it at him and said, "Whatever. It’s all medicine. Knock yourself out." I ignored him and tried to corral the kids. He unzipped it and took a single look. He rolled his eyes and said, "Man, I’m not going through all that. Go ahead." Mary

Response:

I use the Aerogear by the Aerochamber people.  It has an Aerochamber and a Truzone pfm all in a fanny pack.  It is very convenient and also holds about 3 MDI’s.  I can let you know where to get one if you are interested.

Response:

I use the Pulmicort Inhaler (budesonide) this comes with a small spacer.  It measures about an inch square and 3 inches long, expanding to twice its length when used. I find it better than the normal inhaler as it does not effect my throat as the other bectotide did. Steve

Your email address indicates you are in the UK. In the US, Pulmicort is only available as a Turbuhaler (DPI) No spacer is used since it is breath actuated. The best spacer is probably the AeroChamber, a medium size valved device with whistle. For those who want a small spacer for travel, the OptiHaler is very compact, the MDI may be carried in the device. Ellis – Hide quoted text — Show quoted text – Hi all, For those of you who use a spacer when taking oral sprays (as I do) do you take your spacer with you when you travel and if so, how do you pack it/take it with you? Mind’s rather bulky. Thanks for any suggestions. Margaret

Response:

I use the Ellipse spacer; both my Serevent and Flovent fit right into it. That and my peak flow both fit into a small handbag quite easily. Great for carry-on to airplanes! C-ko "ambition makes you look very ugly kicking squealing gucci little piggy why don’t you remember my name you runt?" paranoid android — radiohead

Response:

Hi all, For those of you who use a spacer when taking oral sprays (as I do) do you take your spacer with you when you travel and if so, how do you pack it/take it with you? Mind’s rather bulky.

I own what my family refers to as ‘the suitcase’.  It’s a BIG purse [actually an athletic bag].  Just inside the legal limit for carry-on for the airlines.  Amazing how much stuff you can get in there.  :) Chris Owens

Response:

Hi all, For those of you who use a spacer when taking oral sprays (as I do) do you take your spacer with you when you travel and if so, how do you pack it/take it with you? Mind’s rather bulky. I own what my family refers to as ‘the suitcase’.  It’s a BIG purse [actually an athletic bag].  Just inside the legal limit for carry-on for the airlines.  Amazing how much stuff you can get in there.  :) Chris Owens

 It’s best to carry your spacer, becuase then you can avoid and oral yeast infection.

Response:

When I travel, I pack all my meds, my spacer, and my peak flow meter in an insulated lunch box.  The insulated part was for if they had to sit in the trunk of my car for several hours, like when I’m going home for Christmas break.  So far, I’ve never had any trouble with the inhalers getting too hot or cold, and everything is in one place. janet – Hide quoted text — Show quoted text – Hi all, For those of you who use a spacer when taking oral sprays (as I do) do you take your spacer with you when you travel and if so, how do you pack it/take it with you? Mind’s rather bulky. Thanks for any suggestions. Margaret

Response:

Hi I use the Pulmicort Inhaler (budesonide) this comes with a small spacer.  It measures about an inch square and 3 inches long, expanding to twice its length when used. I find it better than the normal inhaler as it does not effect my throat as the other bectotide did. Steve – Hide quoted text — Show quoted text – Hi all, For those of you who use a spacer when taking oral sprays (as I do) do you take your spacer with you when you travel and if so, how do you pack it/take it with you? Mind’s rather bulky. Thanks for any suggestions. Margaret

Response:

Hi all, For those of you who use a spacer when taking oral sprays (as I do) do you take your spacer with you when you travel and if so, how do you pack it/take it with you? Mind’s rather bulky. Thanks for any suggestions. Margaret

Response:

Hi all, For those of you who use a spacer when taking oral sprays (as I do) do you take your spacer with you when you travel and if so, how do you pack it/take it with you? Mind’s rather bulky. Thanks for any suggestions. Margaret

I have a really nifty spacer. Its no bigger than a ventolin inhaler itself. I can’t get them commercially but they get left as promotional samples at my drugstore. They are made by Boehringer Ingelheim ( in Connecticut ) and are called Inhalation Aids Jerry Freedman,Jr

Response:

:Hi all, :For those of you who use a spacer when taking oral sprays (as I do) do you :take your spacer with you when you travel and if so, how do you pack :it/take it with you? Mind’s rather bulky. I do use one and always take mine with me when I travel. mine comes apart into two sections that fit together (like this!)  / /   / /    / a) In that shape they fit into the pocket of a rucksack (30-40L) and sundries likes the inhalers and/or a PFL can fir into the holow. b) It is also a convenient shape for putting into a suitace, and socks can fill the hollow. :Thanks for any suggestions. :Margaret : : : Barry Landy                        Computer Laboratory:+44 1223 334600 University of Cambridge Computing Service New Museums Site                   Email: Remove "nospam" from above Pembroke Street, Cambridge CB2 3QG

Response:

Question:

I have had asthma since birth, and it was primarily caused by seasonal allergies. ….. in the past year have virtually eliminated my asthma and use of all prescription drugs by using some mega-quality supplements, followed by huge doses of vitamin C and anti-oxidants and grape seed extract……

That sounds like me except I’ve kept a pretty serious regimen of vitamins and exercise without the same auspicious results. I was able to quit taking prescription drugs and inhalers due to a certain non-prescription medication called Haysma. That is until it suddenly dissapeared completely from the shelves of every store (it was sold in most regular grocery stores as well as drug stores) in Salt Lake City. From what I’ve been unofficially informed, it was banned in S.L. & maybe all of Utah because somebody in our LDS-influenced legislature thought it contained harmful substances, esp. caffeine. This isn’t the first time something that is practically benign in the "real" world was 86′d by our gov. Except this time it has caused me to either put up with attacks or go back to the horrible prescription drugs and/or inhalers I thought I was free from. I’m quite sure  that Haysma–there’s probably other comparable products, but this is the only one ever sold around here; because it was supposed to be harmless–is not banned anywhere else. The company, also called Haysma Inc, is still going strong according to the stock market reports. So if anyone out there in non-Mormon land knows where or how I can find it, I’d greatly appreciate an e-mail. Thanks, Mike S.W.

Response:

That sounds like me except I’ve kept a pretty serious regimen of vitamins and exercise without the same auspicious results. I was able to quit taking prescription drugs and inhalers due to a certain non-prescription medication called Haysma. That is until it suddenly dissapeared completely from the shelves of every store (it was sold in most regular grocery stores as well as drug stores) in Salt Lake City. From what I’ve been unofficially informed, it was banned in S.L. & maybe all of Utah because somebody in our LDS-influenced legislature thought it contained harmful substances, esp. caffeine.

According to a quick search I did haysma is listed as containing ephedrine.  The drug ephedrine has been associated with so many serious and fatal reactions that the FDA proposed strict limits on its usage.  These limits would have effectively banned many OTC and ‘alternative’ remedies. (These limits were dropped by the FDA after Congressional pressure.) Due to the presence of known dangers and the ability of lobbyists to prevent federal safety standards, many states have adopted the proposed FDA safety standards on their own. BTW, mixing ephedrine and caffeine is a very, very bad idea.  If haysma does in fact contain both then it is a good thing it was removed from the shelves. "Usenet is like a herd of performing elephants with diarrhea — massive, diffucult to redirect, awe-inspiring, entertaining, and a source of mind boggling amounts of excrement when you least expect it." Gene Spafford 1992

Response:

Another option for manufacturers is to petition FDA, asking the agency to establish the conditions under which the new dietary ingredient would reasonably be expected to be safe. To date, FDA’s Center for Food Safety and Applied Nutrition has received no such petitions. Under DSHEA, once a dietary supplement is marketed, FDA has the responsibility for showing that a dietary supplement is unsafe before it can take action to restrict the product’s use. This was the case when, in June 1997, FDA proposed, among other things, to limit the amount of ephedrine alkaloids in dietary supplements (marketed as ephedra, Ma huang, Chinese ephedra, and epitonin, for example) and provide warnings to consumers about hazards associated with use of dietary supplements containing the ingredients. The hazards ranged from nervousness, dizziness, and changes in blood pressure and heart rate to chest pain, heart attack, hepatitis, stroke, seizures, psychosis, and death. The proposal stemmed from FDA’s review of adverse event reports it had received, scientific literature, and public comments. FDA has received many comments on the 1997 proposal and was reviewing them at press time. Besides FDA, individual states can take steps to restrict or stop the sale of potentially harmful dietary supplements within their jurisdictions. For example, Florida has banned some ephedra-containing products, and other states have said they are considering similar action. Also, the industry strives to regulate itself, the Council for Responsible Nutrition’s Cordaro says. He cites the GMPs that his trade group and others developed for their member companies. FDA is reviewing these GMPs as it considers whether to pursue mandatory industry-wide GMPs. Another example of self-regulation, Cordaro says, is the voluntary use of a warning about ephedra products that his organization drafted. He says that about 90 percent of U.S. manufacturers of products containing ephedra alkaloids now use this warning label. http://www.fda.gov/fdac/features/1998/598_guid.html Ephedra As you know, on June 4, 1997, FDA published in the Federal Register a proposed rule on Dietary Supplements Containing Ephedrine Alkaloids (62 FR 30678). There are a variety of opinions about the proposed rule and the direction the Agency should take. One cannot dispute, however, the shear volume of the reports of illness and injuries that FDA received reported to be associated with the use of dietary supplements suspected to contain ephedrine alkaloids. Between 1993 and mid-1996, FDA received about 1,600 AER’s reported to be associated with the use of dietary supplement products in general. Of these, over half of the AER’s were reported to be associated with the use of dietary supplements that contained, or were suspected to contain, ephedrine alkaloids. These adverse events tended to involve cardiovascular system effects and nervous system effects. FDA evaluated these reports and found that the single most common element was that the products contained, or were thought to contain, a source of ephedrine alkaloids (62 FR 30679). FDA used the information available in the approximately 600 AER’s that were in the Agency’s possession as of June 7, 1996, to describe patterns associated with these reports. A review of the demographic information showed that in over half of the reported adverse events, the injured party was under 40 years of age. Almost 75 percent of the adverse events were reported to occur in females, often using products promoted for weight loss (62 FR 30683). About 59 percent of the adverse events were reported to occur within 4 weeks of starting to use the product. About 14 percent of the reported adverse events occurred on the first day of using the dietary supplement and, in a few cases, on the initial use (62 FR 30684). Overall, the reported signs and symptoms associated with these AER’s included those in which clinically serious events occurred, including heart attack, stroke, psychoses, seizure, and in a few cases, death, as well as those with less clinical significance, including rapid and irregular heart rhythms, increased blood pressure, anxiety, nervousness, tremor, hyperactivity, and insomnia (62 FR 30683). The Agency recognized that these reports could be indicative of early warnings of serious cardiovascular or nervous system risks if product use were to continue. Notably, the information from these adverse events revealed consistent patterns of signs and symptoms in both healthy individuals and in those with underlying diseases or conditions. Many of these reported signs and symptoms occurred in young adults who generally would not have been expected to be at high risk for such conditions (e.g., heart attack and stroke). Included were the deaths of two young adult males in which the medical examiners attributed the cause of death to ephedrine toxicity (ARMS Nos. 10862 and 11134 at 62 FR 30720 and 30722, respectively). In some cases, particular events appeared to reflect individual sensitivities related to dose levels, frequency, or duration of use of ephedrine alkaloids (62 FR 30684). As depicted in Chart C, the ephedra AER’s generated an important "signal", but were just one small component (the "tip of the iceberg") of FDA’s overall analysis of the potential public health risk associated with this product. To better understand the nature and types of products associated with these AER’s, FDA conducted a review of the marketplace (62 FR 30679). Over a two-year period, FDA collected and analyzed over 25 dietary supplement products labeled as containing a known source of ephedrine alkaloids. FDA also searched the scientific literature for relevant clinical studies, case reports, and the expected physiologic and pharmacologic effects. In addition, FDA also convened an ad hoc working group of its Food Advisory Committee (Working Group) and its Food Advisory Committee to consider the public health problems associated with the use of ephedrine alkaloid-containing dietary supplements (62 FR 30680). In the proposed rule, FDA requested comments containing data, particularly clinical data, on the safety of the use of ephedrine alkaloids in dietary supplements. (62 FR 30694). As noted above, while the AER’s served as the warning signal of potential hazard associated with the use of dietary supplements containing ephedrine alkaloids, the Agency’s evaluation of those hazards was comprised of multiple sources of scientific information. This evaluation included the AER’s, a search of the scientific literature, published case reports, controlled clinical studies, and published reports of adverse events associated with traditional uses of ephedrine alkaloids. All of these sources of scientific information revealed a consistent pattern of cardiovascular and nervous system effects associated with ephedrine alkaloids. That view was affirmed by FDA’s Food Advisory Committee. http://www.fda.gov/ola/aems599.html

Response:

I have had asthma since birth, and it was primarily caused by seasonal allergies. It did however flare up at any time, often linked to strenuous exertion, temperature changes and stress. I have been on Tedral, Beclovent, Salbutamol, Ventolin and Flovent. I am now 40, and in the past year have virtually eliminated my asthma and use of all prescription drugs by using some mega-quality supplements, followed by huge doses of vitamin C and anti-oxidants and grape seed extract. The daily vitamin C doses for me (that my body can tolerate without any effects) are around 5000 milligrams. That can vary from person to person. I also made some minor diet changes in cutting back on dairy products and red meat. Hope this information helps. Eric

Response:

Question:

- Hide quoted text — Show quoted text -Nancy wrote….. I went for my physical today.  I sure am glad to get it over with.  He wants me to have cholestrol test done not for anything other than high c runs in the family.  He’s also booking me for a brain scan because my mother has anuerisms and they can sometimes run in the family.  My blood pressure was good and my heart rate was good.  This suprised me because it was thumping like a wild think while I was in the waiting room! He doubled up my dose of Zoloft to 50mg and gave me some more ativan.  Thank God for ativan it seems to be the only thing that is keeping me sane these days. Oh also I am off work for at least another month.  *Phew*  I was worried about that because I am just not ready to go back there yet. I had a nice surprise visit from my brother tonight (who has only been to my place twice before in the past 8 years).  It was a really pleasant visit.  I really like him but we have never had a close relationship. I told the doctor that I had a good day on Sunday but then relapsed on Monday and ever since.  He saw that as a good sign.  At least I had one good day.  I really like him, he is our new family doctor and I only started seeing him when I got this bought of PA he seems pretty thorough.

Dear Nancy, I`m glad to hear that your doctor visit went well. I agree with your doctor that your good day even though it was followed by a setback, is a good thing. You can`t have a setback unless you had made some progress to begin with. The 50 mg increase in your Zoloft dose is a big increase at one time for a person with an anxiety disorder. Just wanted to point that out in case your anxiety or side-effects increase a bit during the next few days. Make sure to use your Ativan during this period. Take care Jackie ~*~The world breaks us all. Afterward, some are stronger at the broken places.

Response:

Hi Nancy! I’m happy that things went well at the doctor’s office.  It’s better to get these tests out of the way and be able to relax afterwards.  It’s great you had such a nice visit with your brother.  I hope you have many more of them. I’m with you about Ativan. Hugs, Di

– Hide quoted text — Show quoted text – Hi All, I went for my physical today.  I sure am glad to get it over with.  He wants me to have cholestrol test done not for anything other than high c runs in the family.  He’s also booking me for a brain scan because my mother has anuerisms and they can sometimes run in the family.  My blood pressure was good and my heart rate was good.  This suprised me because it was thumping like a wild think while I was in the waiting room! He doubled up my dose of Zoloft to 50mg and gave me some more ativan. Thank God for ativan it seems to be the only thing that is keeping me sane these days. Oh also I am off work for at least another month.  *Phew*  I was worried about that because I am just not ready to go back there yet. I had a nice surprise visit from my brother tonight (who has only been to my place twice before in the past 8 years).  It was a really pleasant visit. I really like him but we have never had a close relationship. I told the doctor that I had a good day on Sunday but then relapsed on Monday and ever since.  He saw that as a good sign.  At least I had one good day.  I really like him, he is our new family doctor and I only started seeing him when I got this bought of PA he seems pretty thorough. Sorry for the length, Nancy Depression is merely anger without enthusiasm.

Response:

This is good that you are having all of these tests and that so far, they are showing that you are doing well.  This will take a big load off your mind once all the tests come back negative.  Having the next month off will give you a chance to get used to the Zoloft at a higher dose and let everything settle. Take care, Liz – Hide quoted text — Show quoted text – Hi All, I went for my physical today.  I sure am glad to get it over with.  He wants me to have cholestrol test done not for anything other than high c runs in the family.  He’s also booking me for a brain scan because my mother has anuerisms and they can sometimes run in the family.  My blood pressure was good and my heart rate was good.  This suprised me because it was thumping like a wild think while I was in the waiting room! He doubled up my dose of Zoloft to 50mg and gave me some more ativan.   Thank God for ativan it seems to be the only thing that is keeping me sane these days. Oh also I am off work for at least another month.  *Phew*  I was worried about that because I am just not ready to go back there yet. I had a nice surprise visit from my brother tonight (who has only been to my place twice before in the past 8 years).  It was a really pleasant visit.  I really like him but we have never had a close relationship. I told the doctor that I had a good day on Sunday but then relapsed on Monday and ever since.  He saw that as a good sign.  At least I had one good day.  I really like him, he is our new family doctor and I only started seeing him when I got this bought of PA he seems pretty thorough. Sorry for the length, Nancy Depression is merely anger without enthusiasm.

– Problems are only opportunities in work clothes.                            –Henry Kaiser

Response:

Hi All, I went for my physical today.  I sure am glad to get it over with.  He wants me to have cholestrol test done not for anything other than high c runs in the family.  He’s also booking me for a brain scan because my mother has anuerisms and they can sometimes run in the family.  My blood pressure was good and my heart rate was good.  This suprised me because it was thumping like a wild think while I was in the waiting room! He doubled up my dose of Zoloft to 50mg and gave me some more ativan.  Thank God for ativan it seems to be the only thing that is keeping me sane these days. Oh also I am off work for at least another month.  *Phew*  I was worried about that because I am just not ready to go back there yet. I had a nice surprise visit from my brother tonight (who has only been to my place twice before in the past 8 years).  It was a really pleasant visit.  I really like him but we have never had a close relationship. I told the doctor that I had a good day on Sunday but then relapsed on Monday and ever since.  He saw that as a good sign.  At least I had one good day.  I really like him, he is our new family doctor and I only started seeing him when I got this bought of PA he seems pretty thorough. Sorry for the length, Nancy Depression is merely anger without enthusiasm.

Response:

Question:

No recomendation yet, meeting with Doc next week… — Dan ICQ 108553906

– Hide quoted text — Show quoted text – Folks,          I’ve been on the Paxil for about five weeks now,  feeling better but really experiencing the sexual side effects of the Paxil. I have heard that Serzone gives you all the benefits of Paxil and No sexual side effects.         Can anyone respond both pro and con for switching to Serzone. I’d like to get my drive/libido back. Also if you have made the switch from Paxil how did you do it, were you weaned off the Paxil slowly or just a cold turkey switch to the serzone. Thanks in advance for any and all responses. — Dan ICQ 108553906 serzone does indeed have less sexual interference then the ssri’s-switching is best done by a slow taper off the paxil and once on around 5 mg a day for a week just switching over to a small dose of serzone-initially you may feel fatigued and spacey for a few days to a few weeks if you go too fast upward in the titration-what has your doc recomended? LM

Response:

Folks,           I’ve been on the Paxil for about five weeks now,  feeling better but really experiencing the sexual side effects of the Paxil. I have heard that Serzone gives you all the benefits of Paxil and No sexual side effects.          Can anyone respond both pro and con for switching to Serzone. I’d like to get my drive/libido back. Also if you have made the switch from Paxil how did you do it, were you weaned off the Paxil slowly or just a cold turkey switch to the serzone. Thanks in advance for any and all responses. — Dan ICQ 108553906

Response:

- Hide quoted text — Show quoted text – Folks,          I’ve been on the Paxil for about five weeks now,  feeling better but really experiencing the sexual side effects of the Paxil. I have heard that Serzone gives you all the benefits of Paxil and No sexual side effects.         Can anyone respond both pro and con for switching to Serzone. I’d like to get my drive/libido back. Also if you have made the switch from Paxil how did you do it, were you weaned off the Paxil slowly or just a cold turkey switch to the serzone. Thanks in advance for any and all responses. — Dan ICQ 108553906

serzone does indeed have less sexual interference then the ssri’s-switching is best done by a slow taper off the paxil and once on around 5 mg a day for a week just switching over to a small dose of serzone-initially you may feel fatigued and spacey for a few days to a few weeks if you go too fast upward in the titration-what has your doc recomended? LM

Response:

Danny, I didn’t go from Paxil to Serzone but did go Zoloft-Wellbutrin-Serzone, which I now have been on for about five months.  With the Wellbutrin I ramped off, and then began the "starter pack" of Serzone.  But even the lowest dosage I found intolerable at first – it upset my stomach and made me feel like I had drank ten cups of coffee.  I had to break the beginning pills in half to make it comfortable and move up from there.  Once you’re on it it’s fine, but it’s bumpy getting there. As far as libido or sexual side effects there were none . . . . at first. However (and this could just be me, obviously) at about the four month mark I did start to have problems, similar to what the Zoloft was doing.  It disperses my concentration to the point where it’s very difficult to "finish" in bed.  I don’t know why it took this long to kick in, but it did. I’m currently at 150mg twice a day, and at one point my doc tried to increase it to 400 total.  That DIDN’T work, made me feel like a zombie and totally screwed with my physical coordination, so I went back to 300.  But I’m seriously thinking of ramping off it entirely, not just because of the sexual problem but other side effects as well.  I’ll call my doc and talk about it. Good luck to you, however, and don’t take my experience as a negative for trying Serzone.  I’ve noticed on the other meds many times I have an unusual reaction which just proves we all react differently to some degree. Wayne

– Hide quoted text — Show quoted text – Folks,           I’ve been on the Paxil for about five weeks now,  feeling better but really experiencing the sexual side effects of the Paxil. I have heard that Serzone gives you all the benefits of Paxil and No sexual side effects.          Can anyone respond both pro and con for switching to Serzone. I’d like to get my drive/libido back. Also if you have made the switch from Paxil how did you do it, were you weaned off the Paxil slowly or just a cold turkey switch to the serzone. Thanks in advance for any and all responses. — Dan ICQ 108553906

Response:

Question:

Hi Dianne, I have been taking Zoloft for nearly 12 months. I feel that it is helping me, and would not stop its use. I take 100 mg per day. I have no pain, my circulation in my legs are better. My fatigue level has improved, and in general I feel great. You have to allow it to be in your system for about 4 weeks though, before you start feeling the effects.  I have had no side effects with this medication either. Email me if you like and I will explain in details my improvements to you.   Hope I have helped, Heather. In Australia

Response:

I am currently taking Zoloft.  It makes me feel jumpy and nervous.  Haven’t noticed any improvement as far as fatigue though.  Not sleeping well but I am not sure that is from the Zoloft either.  My 2 cents worth. |     /|   —-    —–       |   /  |  |     |  |     |                      ~~~~~~~~BECK~~~~~~~~ |       |  |     |  |     |                   "Faith ends where worry begins" |       |   —-     —-            

Response:

G’day Diane, I’ve been on Zoloft for over a year now, and my parents tell me it’s made me much easier to live with.  The medication does not start working immediately, so you should wait at least a month before you decide it’s not doing any good.  The starting dosage recommended here in Australia is 50mg daily, so I think your doc has sort of ‘gone the hack’ a bit.  I’m on 100mg and doing fine.  Wish you the best of luck, whatever you decide to do. Catch ya later, Pete Johnson Frankston, Victoria, Australia

Response:

Diane, I was taking Zoloft 100 mg per day for the last 3 yrs for depression and just recently stopped taking it, I chose to stop taking it because I hate taking so many meds and thought I would see if I could do without it. I am doing fine. I never had any side efeects from it and it helped a lot, but like everyone said it takes a few weeks to notice a difference. I also take Amantadine for fatigue since March and it helped alot at first but I am finding I am getting tired again in the afternoon. I was also taking Baclofen for spasms but stopped because it was not helping. You didn’t say how long you have been trying Zoloft, but take it for atleast a month before deciding if it works, because it does take time. Be Well! Denise

Response:

On 28 Sep 1998 22:51:26 GMT, schi…@aol.com (SCHIF99) wrote:

Would like to know if anyone is taking Zoloft….Was taking Elavil, but had too many side effects…so doc switched me to Zoloft 200 mg every day…said it should help the fatigue and the pain…I don’t think it’s working that well at all…still have lots of pain,

I have taken prozac and paxil which are similar SSRI’s.  They take about four weeks to kick in.  They really helped depression, but were less reliable for pain.  However, with the depression under control, I was much more able to cope with the pain. Today my most serious pain is in my back from osteoporosis fractures and the arthritis caused by their healing.  No way would I take any more steroid — let alone monthly.   Be sure that you are getting regular bone density scans. Kate

Response:

Diane – I have taken Zoloft for a few years – find it works well – I take it for the depress- ion – I also have lots of pain – all over – along with sciatica – which I see a chiropractor for about twice a week – the pain is all over – yet my neuro says MS doesn’t include pain – had a bad episode a year ago – went on prednisone – it stopped the pain – but zapped me- felt like I had the flu – could barely get out of bed – would like to learn more about your pain – and what meds you have taken along with their results – thanks so much Brenda

Response:

Would like to know if anyone is taking Zoloft….Was taking Elavil, but had too many side effects…so doc switched me to Zoloft 200 mg every day…said it should help the fatigue and the pain…I don’t think it’s working that well at all…still have lots of pain, still take amantadine for fatigue….problem is i’m really not sure if its worth switching to try something else….I do IV solumedrol once a month (1000 mg)…and sort of look forward to that to cover up my pain for a while…but really don’t want to do that forever either!! Would be great to hear from anyone with any zoloft experience….thanks in advance…diane

Response:

I have been taking Zoloft, 25mg (very low dose) for the depression and fatigue.  It works for me but I also have a lot of shoulder and back spasms and pain which I’ve attributed to MS.  I just found this site that asks questions about antidepressants and low and behold back spasms and pain are side effects of Zoloft sometimes!!

Response:

What’s the URL for the site? Dick Stephens – Hide quoted text — Show quoted text -

I have been taking Zoloft, 25mg (very low dose) for the depression and fatigue. It works for me but I also have a lot of shoulder and back spasms and pain which I’ve attributed to MS.  I just found this site that asks questions about antidepressants and low and behold back spasms and pain are side effects of Zoloft sometimes!!

Response:

KFryk wrote:

I have been taking Zoloft, 25mg (very low dose) for the depression and fatigue.  It works for me but I also have a lot of shoulder and back spasms and pain which I’ve attributed to MS.  I just found this site that asks questions about antidepressants and low and behold back spasms and pain are side effects of Zoloft sometimes!!

On the other hand, my Zoloft was increased when I was having severe headaches, due to muscle spasticity in my neck. Lo & behold, the spasticity in my neck & the headaches have stopped! The moral of this story: everyone reacts differently to meds. Lin ~~ You can tune a piano, but you can’t tuna fish ~~ My header never changes…..look carefully & don’t be fooled by forgeries!

Response:

Question:

Studies show that people talking on car phones are every bit as dangerous as drunk drivers. What if they are drunk and on an AD?

Interesting one, that: I’d have thought that any AD that in particular increases noradrenaline activity would tend to sharpen the senses, and this sometimes seems to cancel out (hmm, not happy with that terminology but it’s been a long day, including having a fight with a train [I won, though am somewhat bruised] so it’ll have to do) some of the alcoholic effects. Chris.

Response:

Studies show that people talking on car phones are every bit as dangerous as drunk drivers. What if they are drunk and on an AD? – Hide quoted text — Show quoted text – ANTI-DEPRESSANT ‘DRIVING HAZARD’ [BBC] Prescribed drugs can impair driving ability more than alcohol, say researchers. In a month-long project, researchers at Surrey University assessed the road handling skills of 16 volunteers who had been given some of the most commonly prescribed anti-depressants. Given the usual standard of driving around here I think that’s the least of their worries.  If I had a choice between getting in a car being driven by a competent driver on antidepressants thought to impair response times or being driven by someone too lazy to even steer their car on the correct side of the road or bother with "give way" signs and so on, I know which my choice would be… Some of the scariest driving I’ve ever witnessed is in the car park of the local supermarket.  I’ve no idea what proportion of drivers are on ADs or not, but in many cases some form of antipsychotic may be useful… and the antics of those responsible for the school run at the local primary defies belief.  Unless they’re trying to kill their own kids, that is. Chris.

Response:

-snip- Jon_WebMD Online Community Moderator

I haven’t posted this in a long long time…. Sincerely Stewart The following "canned response" is simply my personal opinion and expression.  It is not posted as any sort of representation of what others here think.  Some here agree with me on one or more points, while many others disagree with me…….    You have posted a message to the usenet newsgroup alt.support.depression (ASD).  If you are new to this newsgroup, then "Welcome to the group that nobody (in their right mind) wants to join". In the spirit of "real life" support groups, this is often a small and intimate place on the Internet where people can gather together to share their personal experiences.  It is a place that many of us wish we did not feel compelled to frequent, but for which we are often quiet grateful. Everyone is welcome to read what others have written (to lurk as it is called).  Please post responses to others if you think you have something to say that might help them or yourself.  And, of course, we would love to hear a question, comment, rant, or story of your own.    This newsgroup is a completely open forum that is not "moderated" or "staffed" by anyone.  This means that you, me, and the person we BOTH hate, can post whatever they want here.  Although "professionals" of all sorts frequent this group, the opinions expressed here are made by people, not by God, so you might want to consider a second opinion.  Because this group is made up of real people, with all sorts of different opinions, it is often somewhat "volatile".  But you will also find a lot of caring people here that are seriously trying to get a grip on their depression. There are also a lot of people here that want to share their experiences with others.  Personally, it took me several years to realize that the deaths of my father and brother had sent me into a tailspin of depression.  I am happy to say that antidepressant medication and psychotherapy are helping.  I hope you find something here among the throng that helps you.    If you feel compelled to make a request of the group that goes beyond something that would be of benefit to you emotionally, then please reconsider your post.  If you want to request that readers of ASD help you with a project that is only vaguely or indirectly related to your own personal journey, please reconsider your request.  Most of us are working hard to keep our heads above water, or we are trying to help others swim to shore.  We could sure use your help right here.  If you think the people who read this group would benefit from what you know, then please consider providing that information here.  If you feel that you must advertise the experience or information that you posses because it cannot be provided here, then please consider whether or not this is really an appropriate place to advertise.  While this is certainly an appropriate place for ANY information related to depression, please remember that there are LOTS of people out there with equally worthy projects.  If they all post here, then this will soon be a place full of pointers to a lot of worthwhile information, but it will cease to be a place of much support. Often a good way to advertise is to respond to a personal post, and place your advertisement in your signature file.    I have sent this reply to you personally.  I have also posted it to the group so that anyone can read it if they want to.  Please keep an eye out for the depression/ASD FAQ (Frequently Asked Questions), the User Guide to ASD, and the ASD Flame Retardant, which are all posted from time to time on this newsgroup.  You can also find these and other important tidbits of information about this newsgroup at the world wide web site http://www.lava.net/~dewilson/asd/resources.html Good luck Sincerely Stewart PS.  Remember that I am just another idiot with my own stupid personal opinions.  Other idiots here have their own stupid personal opinions. — The Metaphor Man  *and*  The Great Defender of the Self (remove the SPAMBLOCK) Please send me an e-mail copy of your posted response.

Response:

ANTI-DEPRESSANT ‘DRIVING HAZARD’ [BBC] Prescribed drugs can impair driving ability more than alcohol, say researchers. In a month-long project, researchers at Surrey University assessed the road handling skills of 16 volunteers who had been given some of the most commonly prescribed anti-depressants.

Given the usual standard of driving around here I think that’s the least of their worries.  If I had a choice between getting in a car being driven by a competent driver on antidepressants thought to impair response times or being driven by someone too lazy to even steer their car on the correct side of the road or bother with "give way" signs and so on, I know which my choice would be… Some of the scariest driving I’ve ever witnessed is in the car park of the local supermarket.  I’ve no idea what proportion of drivers are on ADs or not, but in many cases some form of antipsychotic may be useful… and the antics of those responsible for the school run at the local primary defies belief.  Unless they’re trying to kill their own kids, that is. Chris.

Response:

WebMD Community Services Depression Community Update for the week of June 21, 1999 http://my.webmd.com YOU ARE NOT ALONE! THERE ARE NOW MORE 15,000 PEOPLE SUBSCRIBED TO THE DEPRESSION DISCUSSION GROUP. THE BIG NEWS THIS WEEK IS THAT WE NOW HAVE A MESSAGE BOARD EXPERT TO ANSWER YOUR QUESTIONS ABOUT DEPRESSION!!! (see below for details) QUICK CHAT TIP: HAVING PROBLEMS? TRY ENTERING THE CHAT ROOMS WITH THE JAVA-LITE CLIENT. —  See http://my.webmd.com/calendar a complete         list of upcoming chats ** Upcoming Chat ** CHAT:           Functioning in the Workplace GUEST:          Beth Phoenix Kasten, R.N., Ph.D. of UCSF TIME:           3 p.m. Pacific (6 p.m. Eastern, 10 p.m. GMT) WHERE:          WebMD_Auditorium http://my.webmd.com/event/341508 WebMD is proud to welcome back Beth Phoenix Kasten, R.N., Ph.D. of UCSF on Tuesday, June 22 at 3 p.m. Pacific (6 p.m. Eastern, 10 p.m. GMT) when she discusses the topic, Functioning in the Workplace. As many of you know, Beth Phoenix Kasten, R.N., Ph.D. is an Associate Clinical Professor at UCSF School of Nursing. She has chatted with us before on a variety of depression issues, and is available to answer your questions and point the way towards useful resources. This special event will take place in the WebMD_Auditorium. * * * * * * * * * * * * * ** This Week in Chat ** Last week, we welcomed WebMD welcomed author Sam Vaknin, on Monday, June 14 when he discussed Narcissistic Personality Disorder moderator       Why did you decided to title the book                 "Malignant Self Love?" Speaker         Narcissism is an exaggeration, a malignancy of                 a healthy phenomenon. Self Love helps survivals —                 It is a prerequisite. But when overdone and when                 derived exclusively from the outside, it is                 malignant, it kills, emotionally. moderator       …What do you mean, "derived exclusively from the                 outside?" speaker         A Narcissist (notice the capital N) has no sense of                 self. If not reflected by others, he feels annulled,                 dead, void… It is a harrowing experience                 (I went through it once).                 It is like being separated to molecules and                 suspended in mid air. READ THE REST — http://my.webmd.com/member/522878 ALSO AVAILABLE FROM WEBMD: The Emotional Challenges of Long-Term Caregiving Transcript —  http://my.webmd.com/member/522684 * * * * * * * * * * * * * ** New in Medical News ** ANTI-DEPRESSANT ‘DRIVING HAZARD’ [BBC] Prescribed drugs can impair driving ability more than alcohol, say researchers. In a month-long project, researchers at Surrey University assessed the road handling skills of 16 volunteers who had been given some of the most commonly prescribed anti-depressants. READ — http://news.bbc.co.uk/hi/english/health/newsid_374000/374290.stm COMMENT — http://my.webmd.com/roundtable_message/229754 REMARKS BY THE PRESIDENT, THE FIRST LADY, THE VICE PRESIDENT, AND MRS. GORE AT WHITE HOUSE CONFERENCE ON MENTAL HEALTH EXCERPT: MRS. GORE: Wow! Thank you so very much for that warm welcome. Good afternoon. We are all so very pleased to be hosting the first White House Conference on Mental Health. And I want to thank Michael Stevenson for producing the film that you just saw, with its extraordinary spirit showing the faces of mental illness. Thank you very much, Michael. READ — http://www.mentalhealth.gov/remarks.asp COMMENT — http://my.webmd.com/roundtable_message/229762 MENTAL HEALTH PARITY: ITS TIME HAS COME, ACCORDING TO APA American Psychological Association: No matter the form, discrimination is wrong. Yet, nearly 98% private health insurance plans discriminate against patients seeking treatment for mental illness by requiring higher copayments, allowing fewer doctor visits or days in the hospital, or higher deductibles than imposed on other medical illnesses. This discrimination results from outdated misconceptions and the stigma surrounding mental illnesses. If left to continue, the financial and human costs of untreated mental illness will far exceed the costs purported by opponents

Question:

ok, i’m back on zoloft and waiting for the effects to kick in. the last time around, i think it actually precipitated something close to a panic attack. i’m not so sure i’m looking forward to the other side of the pendulum either. anyone else get this? Dawn. International student Second year Media Studies RMIT University, Australia (Melbourne) "Maybe I -will- become a writer, and maybe I won’t. I don’t know. I haven’t read the last page yet."      - Julia Salinger, Party of Five

Response:

Dawn,    Several SSRIs cause a feeling of panic, jumpiness, and impending doom until they "kick" in. Paxil nearly wiped me out when I went on it. Luckily (?) I was in the hospital when I was put on Zoloft a few years ago. Anyhow, after about 3 weeks of feeling like shit, the drug kicked in and I did feel a bit better. My Best,  ~Robbi~  "oo" http://www.geocities.com/SoHo/7160 for all of your bipolar needs. Serving bipolars since 1996!              The sex organ is a terrible thing to waste! P.S. The last remark on my sig line is dedicated to the sexual dysfunction that occurs in 25% of people taking antidepressants. The 25% figure is based on medical information which is suspect.

Response:

What are the side effects of Zoloft?  Guess I should be prepared for them Kimber

Response:

Question:

Hi.  I’ve been on Prozac fort Attention Deficit Disorder for about two months now.  I recently started having problems with insomnia. My Psychiatrist started me on trazodone (Desyrel) in the evenings to help me sleep, but I seem to be getting some bad side effects from it (indigestion, trouble concentrating, and sexual problems). Here’s my question.  It seems like Psychiatrists have a reluctance (justified I’m sure) to prescribe hypnotics or other strong sleep medications to overcome the insomnia that is fairly common with Prozac.  Does anyone out there know what is used apart from the other anti-depressants (e.g., trazodone and amitriptyline)? Has anyone actually had their Psychiatrist prescribe them Halcion or something similar? Would over-the-counter sleep medications do any good? Since I am being treated for ADD, any drugs that take a long time to wash out, or leave my mind feeling "dull" are out of the question. As always, thanks for any and all help. — | Richard S. Smith  | PROGRESS(tm) 4GL Developer | Monrovia, California  |

Response:

: Hi.  I’ve been on Prozac fort Attention Deficit Disorder for about : two months now.  I recently started having problems with insomnia. : My Psychiatrist started me on trazodone (Desyrel) in the evenings to : help me sleep, but I seem to be getting some bad side effects from : it (indigestion, trouble concentrating, and sexual problems). : Here’s my question.  It seems like Psychiatrists have a reluctance : (justified I’m sure) to prescribe hypnotics or other strong sleep : medications to overcome the insomnia that is fairly common with : Prozac.  Does anyone out there know what is used apart from the : other anti-depressants (e.g., trazodone and amitriptyline)? : Has anyone actually had their Psychiatrist prescribe them Halcion : or something similar? : Would over-the-counter sleep medications do any good? : Since I am being treated for ADD, any drugs that take a long time to : wash out, or leave my mind feeling "dull" are out of the question. : As always, thanks for any and all help. : — : | Richard S. Smith  | PROGRESS(tm) 4GL Developer | Monrovia, California  | i’ve found a good drink helps the most. i can’t stand the feeling of sleeping pills after one night of them. drink in moderation

Response:

: Hi.  I’ve been on Prozac fort Attention Deficit Disorder for about : two months now.  I recently started having problems with insomnia. By the time insomnia kicks in with any of these drugs, chances are the good effects are diminishing too. I question the long term use period. Halcion would give you a double whammy. It might work one or two nights a week and set you up for some unexpected side effects. If you have no physical problems, consider exercise and walks and interventionist type psychologists. Avoid Freudians. —                                              And this is where                                              they spin gold into                                              straw.

Response:

: By the time insomnia kicks in with any of these drugs, chances are the : good effects are diminishing too. I question the long term use period. What is long term use?  I was on Prozac for 2+ years before my body started getting used to it and I had to try another SRI.  The good effects started 1 1/2 days after starting it, and I never had what I would characterize as insomnia. : If you have no physical problems, consider exercise and walks and : interventionist type psychologists. Avoid Freudians. Too bad psychologists have never been proven to work.  The changes I had in 1 1/2 days could not have been wrought by psychologists in 20 years.

Response:

Too bad psychologists have never been proven to work.  The changes I had in 1 1/2 days could not have been wrought by psychologists in 20 years.

Hehehee.  Thank you Jeanne, I enjoyed that.  No offense intended to any professional people out there (and it certainly took me more than 1 1/2 days to see effects from my first antidepressant), but I know exactly what you mean.  :) lilo

Response:

               ….. The best drug yet for add. Hits all 3 brain                interactions. seriton, … Helps me concentrate without                the stimatues like dexadrine, ritalitin,….                 Effexor FAQ  Version 1.0  3 March 1994                                   Index. 1. What is Effexor 2. How does Effexor differ from other antidepressants? 3. What kinds of depression can be treated with Effexor? 4. What are the side-effects of Effexor? 5. Which side effects force people to stop taking Effexor? 6. Are there any special hazards for people with bipolar disorder? 7. Does Effexor interact with other medications? 8. Does Effexor interact with alcohol? 9  Is Effexor safe for a woman who is pregnant, about to become pregnant,    or nursing an infant? 10. How is treatment with Effexor initiated? 11. What is the usual final dose of Effexor? 12. Are there withdrawal effects if Effexor is suddenly discontinued? 13. Is Effexor toxic if an overdose is taken? 14. What will Effexor cost? 15. When will Effexor be available? 16. Additions and corrections. 1. What is Effexor         Effexor is a new antidepressant with a novel chemical structure.  The chemical structure of Effexor does not resemble those of any currently used antidepressants.  Effexor is not an MAO inhibitor 2. How does Effexor differ from other antidepressants?         Effexor seems to have the relative freedom from side-effects associated with the SSRIs [fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox)] and the impact on both the serotonin and norepinephrine associated with the tricyclic antidepressants (amitriptyline (Elavil), inipramine (Tofranil) etc.).  It is hypothesized that the action of the Effexor molecule upon both serotonin and norepinephrine will cause Effexor to be a successful antidepressant for some people who have not responded to treatment with SSRIs. 3. What kinds of depression can be treated with Effexor?         While the pre-marketing studies were restricted to patients with a DSM-III-R diagnosis of Major Depressive Disorder (with or without melancholia), it is to be expected that Effexor will be prescribed for patients with Dysthymia, Major Depression, and Bipolar Disorder.         Although here have been no published studies on the use of Effexor for the treatment of children and adolescents with depression, it can be expected that the drug will be prescribed for depressed children and adolescents.         No special problems were encountered when Effexor was prescribed for elderly people with depression.         While Effexor was only studied for periods of administration of up to 6-weeks, it is to expected that patients with long-standing depressions will take the drug for longer periods of time. 4. What are the side-effects of Effexor?         The most common side-effects and the percentage of people reporting them during clinical trials are:                                 Nausea                  37%                                 Headache                25%                                 Sleepiness              23%                                 Dry mouth               22%                                 Dizziness               19%                                 Insomnia                18%                                 Constipation            15%                                 Nervousness             13%                                 Fatigue                 12%                                 Sweating                12%                                 Decreased appetite      11%                                 Male sexual dysfunction 12%                                 Female sexual                                           Dysfunction    2% 5. Which side effects force people to stop taking Effexor?         In the premarketing studies  19% (537 / 2897) of depressed patients taking Effexor discontinued the medication because of side-effects. The side effects and the percentages of total patients who dropped out for each are:                                 Nausea                  6%                                 Sleepiness              3%                                 Insomnia                3%                                 Dizziness               3%                                 Male sexual dysfunction 3% *                                 Headache                2%                                 Nervousness             2%                                 Anxiety                 2%                                 Dry mouth               2%                                 Fatigue                 2%                                 Sweating                2%                                            * % of men 6. Are there any special hazards for people with bipolar disorder?         As with other antidepressants, people with bipolar disorder who are not being treated with a mood regulator such as lithium, valproate (Depakote), or carbamazepine (Tegretol), may be pushed into a manic episode when treated with Effexor. 7. Does Effexor interact with other medications?         Lithium – No interaction         Diazepam (Valium) – No interaction         Cimetidine (Tagamet) – Slight increase in blood level of         Effexor’s active metabolite.  Not of clinical significance.         Fluoxetine (Prozac) – Significant increase in the concentration         of Effexor and its active metabolite.  Potential for increased side-         effects. 8. Does Effexor interact with alcohol?         Although Effexor has not been found to increase the impairment of cognitive or motor skills caused by alcohol, the manufacturer warns against drinking while taking Effexor. 9 Is Effexor safe for a woman who is pregnant, about to become pregnant,   or nursing an infant?         There is no data to establish the safety of Effexor for the fetus   or nursing infant. 9. How is treatment with Effexor initiated?         The usual starting dose of Effexor is 75 mg a day taken in two or three divided doses with food (to minimize nausea).  If higher doses are needed, the dose should not be increased more rapidly than 75 mg every 4 days. 10. What is the usual final dose of Effexor?         While doses up to 375 mg per day are approved by the FDA, some severely depressed patients have been treated with higher doses.  Most depressed people have been found to respond to doses under 300 mg per day. 11. Are there withdrawal effects if Effexor is suddenly discontinued?         Effexor should be discontinued gradually over at least 2-weeks.  If Effexor  suddenly discontinued, a withdrawal syndrome involving fatigue, nausea, dizziness, headache, insomnia, and nervousness, may develop. 12.  Is Effexor toxic if an overdose is taken?         Fourteen overdoses of Effexor have been reported.  In some cases Effexor was taken along with alcohol and/or other medications.  All individuals who took an overdose recovered without sequelae. 13. What will Effexor cost?         Effexor will be supplied in tablets ranging from 25 to 100 mg in strength.  The 25 mg tablets cost pharmacies nearly as much as the 100 mg tablets.  It is expected that all strengths of Effexor will be sold for between $1.00 and $1.50 per tablet. 14. When will Effexor be available?         A few psychiatrists have been given small supplies of Effexor. It is expected that Effexor will be widely available by the first week of April of 1994. 15. Additions and corrections.         This FAQ was prepared by Ivan K. Goldberg, MD.  Please address —                                                                 \\         ||                             Ivan Goldberg, MD                 ~        || ||    Voice Mail = 212-744-1846      ||      Fax = 212-737-0473           || || Snail Mail = NY Psychopharmacologic Inst. 1346 Lexington Ave NYC 10128 || : Hi.  I’ve been on Prozac fort Attention Deficit Disorder for about : two months now.  I recently started having problems with insomnia. : My Psychiatrist started me on trazodone (Desyrel) in the evenings to : help me sleep, but I seem to be getting some bad side effects from : it (indigestion, trouble concentrating, and sexual problems). : Here’s my question.  It seems like Psychiatrists have a reluctance : (justified I’m sure) to prescribe hypnotics or other strong sleep : medications to overcome the insomnia that is fairly common with : Prozac.  Does anyone out there know what is used apart from the : other anti-depressants (e.g., trazodone and amitriptyline)? : Has anyone actually had their Psychiatrist prescribe them Halcion : or something similar? : Would over-the-counter sleep medications do any good? : Since I am being treated for ADD, any drugs that take a long time to : wash out, or leave my mind feeling "dull" are out of the question. : As always, thanks for any and all help. : — : | Richard S. Smith  | PROGRESS(tm) 4GL Developer | Monrovia, California  | — Scott Onofrio                            LaserJet IHV Developer Group

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Response:

(Jeanne Guidry) writes:

I just started Prozac in conjuction with Cylert and have noticed no effects after a week; moreover, my psyc said that the clinical effects probably won’t be evident for at least a month, although I might see some changes, most notably side effects, earlier.  So far, so good–no headaches, insomnia, etc. But then again, my biochem is probably different as Ritalin had little clinical effect on me.

Response: