Anafranil: Old School Anti-Obsessional... Any experience?

[Kobayashi]

Seeing my GP today. Haven't been feeling much better. I'm wondering if I need an increase in dosage, or perhaps there is too much going on with both cipralex and anafranil. Feeling agitated, blue, foggy. It's likely just start up side effects...But going through this ain't fun

 

[David Baxter PhD]

Seeing my GP today. Haven't been feeling much better. I'm wondering if I need an increase in dosage, or perhaps there is too much going on with both cipralex and anafranil. Feeling agitated, blue, foggy. It's likely just start up side effects...But going through this ain't fun

I think it's been long enough now (if memory serves, it's been more than a week now, right?) that you may want to ask your doctor about a change, given the side-effects you've been experiencing. In any case, make sure your doctor is aware of how you've been feeling on the current medications.

If your doctor does decide to go with a change of medications, ask him/her about Luvox (fluvoxamine), which is an SSRI that is known to have better anti-obsessional properties than most. It should be an easy transition from Cipralex to Luvox.

Note: If you do switch to Luvox, be aware that there is some evidence that the generic is not as effective as the brand name. There's no harm in trying the cheaper generic first if you don't have some sort of drug plan but if you do have a good drug plan it might be worth asking your doctor to specify the brand name on the prescription.

 

[Kobayashi]

Thanks Doc - Its been 7 days now at 25mg of Anafranil. I take it at night. Take my 25mg of cipralex in the am. First few days it had a calming effect. I've definitely noticed in the past few days that I'm having increased rumination and feeling generally depressed. I dhould mention that I felt this way when starting cipralex as well. I did manage to push through and after a week or so felt much better. Is that something that could be happening here? I've read that some people can have increased anxiety etc when starting up TCA's.

 

[David Baxter PhD]

My general feeling is that if you're not seeing a diminishing of the side-effects after 5-7 days, it's probably not just an adaptation effect but rather a side-effect that's not going to go away.

Your doctor may want you to try another week, given your history with Cipralex, but if it seems to be getting worse rather than better I wouldn't be optimistic. Certainly raise the issue with your doctor and see what s/he has to say about it, but I would recommend that you at least ask about Luvox.

 

[Kobayashi]

Will do. thanks for your input. As a side note I did great on Cipralex for approx 7 months, with very little OCD and non-existent anxiety. It helped a great deal while doing CBT. I started to feel physical anxiety settle in along with OCD in increasing amounts so they upped my cipralex dosage and added risperidone. Risperidone helped a bit, but it didn't last. Hoping to find a med as part of the solution here soon.

---------- Post added at 03:44 PM ---------- Previous post was at 01:19 PM ----------

Went to see my GP. She want's me to stay the course for a few more days with the anafranil. I see her again in a week. If I continue to feel crummy, I was told to stop the anafranil and we'll look at Luvox as an option. She just wants to ensure that we aren't missing a potential window of opportunity with the anafranil.

 

[David Baxter PhD]

Sounds like a plan. Good luck, Kobayashi.

 

[amastie]

.. Not only does that low dose control the blood pressure very well, but I have no side-effects at all. An added bonus is that I went from $80 - $100 per month on the newer medications to a cost of about $16 for a 3 month supply of the current medication.

Good one! :2thumbs:

---------- Post added at 01:18 AM ---------- Previous post was at 01:13 AM ----------

..As a side note I did great on Cipralex for approx 7 months, with very little OCD and non-existent anxiety. It helped a great deal while doing CBT...

I tried Lexapro - the name for it in Australia - (at least I think I have) but it didn't seem to help me. After someone else mentioned how much it helped her, I'm gong to talk to my psych about it again, or at least something in the same family. It would be great to take less Xanax, which is the only med (apart from Valium in the past) which works for me. I've been on so many and nothing else has ever had a long-term benefit.

 

[Kobayashi]

Eech! Ok - I'm done with Anafranil. Feeling even worse. Now depression has set in...horrible OCD thoughts on the rise. This ain't good. Now I get to deal with a double dose of AD withdrawal too. (Hopefully it isn't that bad as the dose was low and I was on on it briefly). My instincts are telling me now that this stuff isn't for me. Too bad - I had high hopes for it. I'm moving on and will ask to try Luvox next. Got to love the medication merry-go-round...

 

[Kobayashi]

Ok - So I went back to my Doc today. I've been having these strange cycles on cipralex. Two weeks of "ok" and feeling relatively good, followed by a predictable crash into high anxiety and increased OCD. So I mentioned the Fluvoxamine and she's agreed to give it a shot. She's prescribed the brand name, not the generic. So - now I need to taper from Cipralex to the Luvox. I'm currently at 25mg of the Cip and she wants me to add 50mg of the luvox at bedtime for two weeks and see how things go. She didn't seem sure if this was a proper tapering schedule, but didn't seem concerned about serotogenic reactions.

I'm off to Mexico for a week over the March break, and part of me is wanting to wait till I get back to start this change. Not sure what I'm afraid of - maybe that it will make me worse or something.
Anyone have any insight as to what I might expect with the switchover?

Kob.

My general feeling is that if you're not seeing a diminishing of the side-effects after 5-7 days, it's probably not just an adaptation effect but rather a side-effect that's not going to go away.

Your doctor may want you to try another week, given your history with Cipralex, but if it seems to be getting worse rather than better I wouldn't be optimistic. Certainly raise the issue with your doctor and see what s/he has to say about it, but I would recommend that you at least ask about Luvox.

 

[David Baxter PhD]

Most people will find it's a pretty smooth transition. In wouldn't expect anything drastic other than a gradual improvement in OCD symptoms over time. You may not notice a profound effect until you're up to 100 mg or greater, though.

 

[Kobayashi]

Most people will find it's a pretty smooth transition. In wouldn't expect anything drastic other than a gradual improvement in OCD symptoms over time. You may not notice a profound effect until you're up to 100 mg or greater, though.

Thanks Doc. Do you think the cross-taper is ok? 50mg of Luvox AND 25mg of Cipralex?

 

[David Baxter PhD]

I think your doctor is being conservative but that's often a good thing in medicine.

The risk of any major problems following her instructions is very low, I would say, based on my experience with clients who have made similar transitions.

 

[Kobayashi]

So its been a week on a combination of 20mg cipralex and 50mg Luvox. I swear - for the first 5 days I felt calmer, less anxious and my intrusive thoughts were slightly diminished. I know that's unusually quick, but I definitely felt a difference. Today is day 7. The past day or two has not been great. I feel like I've slipped back to where I was prior to starting...anxious, depressed and increased rumination. I wonder if I could do with bumping up the Luvox? Problem is, I can't get in to see my Doc until March 1st. Would it do any harm to increase the luvox say by 25mg? I have plenty on hand. I know we shouldn't do these things without Drs consent, but I want to see if this med can give me some benefit by a slight increase. I know my Doc's plan was to increase the luvox if I tolerated it well. I've had pretty much zero side effects, except a bit of fatigue and that things have been very "delayed" in the bedroom. That's likely due to having both cipralex and luvox in my system. Something I'm willing to live with for now....

Kob.

 

[David Baxter PhD]

Cipralex and Luvox are both SSRIs. I assume your doctor planned to reduce the Cipralex when the Luvox was to be increased.

I think you need to call your doctor's office, either to ask the question or to see if you can move up the appointment.

 

[Kobayashi]

Yes - the plan is to reduce the cipralex, by 5mg increments over time. Not sure how much the Luvox would be increased. I tried to move up the appt, but unfortunately I can't get in until March 1st. I have already reduced the cipralex by 5mg.

 

[David Baxter PhD]

Try calling the doctor's office then for advice. I think the doctor is going to want to decrease the Cipralex further before increasing the Luvox.

 

[Kobayashi]

Darn it. She's on vacation until the end of Feb, backup is only available at the emerg. Wish I could find some sort of a cross tapering schedule for these meds.

 

[David Baxter PhD]

Given that your doctor is already trying to taper, you could ask your pharmacist for advice on how to proceed. Does your doctor not have a backup who could answer your questions?

We really cannot give you advice on this here, for legal and ethical reasons, not to mention liability. All I can say is that it's likely not a good idea to unilaterally increase the Luvox without a further decrease in Cipralex, unless your doctor has some reason for wanting you on a higher combined dose right now.

 

[Kobayashi]

Maybe I should just leave things till she gets back. Trouble is - I really felt an initial positive benefit from the luvox. I have some ativan which she prescribed for the transition. I've been taking it very sparingly - .5mg every other day for the past few days.

 

[David Baxter PhD]

I understand. I don't think there's much doubt that you're going to want to increase the Luvox but you don't want an SSRI overdose to complicate your life (Luvox and Cipralex are both SSRI medications).

On the other hand, March 1 is still 6 weeks away. My guess is that if you consulted her backup doctor you would be given advice on the next step to transition from Cipralex to Luvox. That's the route I would take if it were me.