When Is It Too Much?

[PTSDbegone]

I am starting to really question my Psychiatrist. In the morning I am taking Prozac and Celexa. In the evenings I am on Seroquel and Prazosin. Doses are high for the Prazosin, but the others are somewhere in the middle I believe. Not low, but not high either. I am wondering if it's too much. I feel so blah all the time. I feel as though I am groggy all day, and just want to sleep. Then at night I am wide awake and can't sleep even with taking the Seroquel. I was originally taking the Prozac in the evening, but switched that about 2 weeks ago to the mornings. Just wondering if it's too much maybe?

 

[Sammyiam]

Hi,
I am the same and I was on seroquel and prazosin at night and venlafaxine. I have had to stop the prazosin because it has given be really bad hay fever type feelings and hard to breath like asthma. What dose of seroquel and Prazosin are you on daily ?

 

[iwannadeletethis]

I am starting to really question my Psychiatrist. In the morning I am taking Prozac and Celexa. In th...

@PTSDbegone
hi!
I'm sorry.. This sounds awful!! If I were in your shoes.. I would think about how I am without the meds vs with the meds. Think about some pros and cons and try to talk to the psychiatrist about lowering the dosage.

 

[joeylittle]

Then at night I am wide awake and can't sleep even with taking the Seroquel.

I would recommend talking to your doctor about discontinuing the seroquel or the prazosin. Personally, I'd say stop the seroquel, only because I think it's good practice to only take the minimal number of psychotropic drugs, and prazosin is not a psychotropic.

Seroquel is notorious for creating a fuzzy, groggy, vacant kind of feeling. If it is not helping you with sleep, it may be managing some daytime anxiety - but you won't know till you back down off your current dose or take that all the way to discontinuation.

You can't stop seroquel all at once - you need to work out a schedule with your doctor.

 

[Deleted member 1860]

Is there a reason for two different antidepressants? Is your doctor monitoring your doses and watching out for seratonin syndrome? (It can happen when you have too many drugs in your system that work on seratonin, or too high of a dose of one drug even.)

 

[hodge]

I agree with Joey. If it came down to a choice between Seroquel and Prazosin, I'd choose Prazosin for the nightmare relief, especially since the Seroquel is not doing the job of helping you sleep.

 

[PTSDbegone]

Thank you everyone.

I only started on the seroquel last month for anxiety and sleep. I am currently on 100mg. The Prazosin I have been on 10mg for almost 2 years. I wasn't sure if the Prazosin was actually helping until I had a hard time finding a pharmacy that had it in stock for approximately 2 months. I noticed when I wasn't taking it that the nightmares were more intense. For those 2 months I was taking Nabilone instead of the Prazosin. I didn't notice the Nabilone helping so when the Prazosin was available again I went back to it.

I have noticed less anxiety (I sort of miss it). However I don't know if I feel exhausted from all the work I am doing, or if it's the medication. How does one know if the medication is actually helping?

 

[hodge]

If you feel less anxious, then maybe the Seroquel is helping?

 

[PTSDbegone]

Yes it could be helping I guess. I have traded in the anxiety for depression it seems. I figure any change is good change, but not liking this one.

 

[hodge]

Yeah, I've been there. I still have depression, but the anxiety has been more dominant in recent months. I hate them both. My psychiatrist recently told me that now there is genetic testing available that can determine the best antidepressant for a person. I don't know if your health care system would cover it (Medicare in the US covers it, he said), but it sounds worth looking into. And I know more meds may not be what you have in mind, but it might help?

 

[Ivan the Elder]

It is time to find another psychiatrist. The combination of drugs you are taking is dangerous. Before I say anything else I warn you to not suddenly stop taking anything you are taking now. Note: I am not a doctor.

First, you should not be taking Celexa. That is Citalopram and was some time ago replaced by a much purer form that results in the dose required to be reduced by three to four times with the same effect. This is much safer. The drug is ESCitalopram with one brand name Cipralex. I take it and use only a 5 mg dose and it works well.

The Prozac, Celexa and Seroquel all have the effect of increasing your QT interval in your heart. Taking even one of these is a good reason to have an ECG done to verify your QT interval is still in a safe range. Taking three drugs that increase QT interval is just plain dangerous and could easily increase the heart QT interval enough to cause sudden death due to an electrical heart attack. There is no good reason to be taking these three drugs at the same time.

Here are warnings from Medscape, a website that is part of WebMD and works directly with the FDA.

Prozac (fluoxetine)
Serious - Use Alternative
citalopram and fluoxetine both increase serotonin levels. Possible serious or life-threatening interaction. Monitor closely. Use alternatives if available. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

Celexa (citalopram)
Serious - Use Alternative
citalopram and fluoxetine both increase serotonin levels. Possible serious or life-threatening interaction. Monitor closely. Use alternatives if available. Combination may increase risk of serotonin syndrome or neuroleptic malignant syndrome-like reactions. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

Seroquel (quetiapine)
Significant - Monitor Closely
quetiapine, fluoxetine. Either increases toxicity of the other by QTc interval. Potential for interaction, monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

The Prazosin is an alpha blocker and does not interact dangerously with the others. It is used to regulate blood pressure. It may however reduce clotting and platelet levels which is also a possible side effect of Celexa and Prozac. If you have any issues with platelets then that should be checked with a complete blood count (CBC).

Rule one, Talk to your Doctor before you change anything.

 

[Ivan the Elder]

One thing I forgot to mention: Because of the drugs you are taking you should keep an eye out for any trace of blood in your stools. If you have any that is most likely a direct side effect of reduced clotting caused by the drugs I mentioned. It isn't good for your brain either as it can lead to hemorrhagic stroke. I am not trying to scare you but you very much do need to change your drug load. It is too much of the wrong combination.