Prozac Weekly (With Adderall XR)??

[wifeandmom]

DD, almost 18, has been on Adderall XR 40 mg am with 10 mg IR booster after lunch. She's been treated previously for depression with Lexapro (turned her into a sleepwalker) and Wellbutrin XL (worked pretty well, but seems to have caused some problems with memory and DD isn't on a reliable enough schedule to take daily).

Her PDoc prescribed Prozac Weekly. We are going to start it this weekend. She's always home on Sunday and that day I can help make sure she takes it.

Does anyone have any experience or advice regarding Prozac in the once a week dose, particularly with Adderall?

Thanks in advance!

[wifeandmom]

No one?


(I hear crickets)

[Aquablue]

Shoo Shoo Shoo
......okay crickets made room for me....


Hi Wifeandmom,

This may not be much help, especially the info. on once weekly prozac which is based on findings of a study I read awhile ago, not on personal experience or that of someone I know.

A controlled study comparing daily and weekly prozac found no significant difference in the effectiveness of daily vs. weekly prozac. As to side effects, neither the likelihood nor frequency of occurence was greater with one format than the other.

I recall noting that efficacy had alredy been established in the "once weekly" group prior to the study -- subjects took prozac daily for several months prior and it reduced their symptoms considerable. Thus a limitation of the finding is that subjects just starting on prozac were not represented in the weekly group. I wasn't sure from your post if DD is just starting on prozac; my impression was that she is. If so, she'll need to be monitored especially close in the first month as signs of inefficacy or negative side effects may have nothing to do with "weekly" but rather with the drug itself.

I've known a few people with Adhd who responded favorably to a similar regimen, meaning a serotonin reuptake antidepressant + amphetimine. Again, DD needs to be monitored closely at the start. There are side effects to look for and report immediately if they occur including altered consciousness, rapid heartbeat, and neuromuscular problems. There's a very rare and serious syndrome associated with mixing these two categories of drugs known as Serotonin Syndrome, which involves hyperstimulation of certain brainstem receptors. I'm not an MD and so cannot say for sure but the dosages she's on seem moderate therefore the risk of such a problem is minimal. One last thing, it's important that DD let the doctor know anything else other than food that she's ingesting. Vitamins, minerals, holistic remedies etc.

An acquaintance at my place of work is on adderall as well as a serotonin reuptake drug, cymbalta. She's not experiencing ill side effects however has said the effectiveness of adderall is reduced since starting on cymbalta. I don't think that's so odd, as simultaneously increasing serotonin (via cymbalta, prozac etc.) and dopamine (via adderall, dexedrine etc.) may produce interactions that have a cancel out effect, The potential danger, though, if the adderall no longer helps with inattention/focus difficulties, is if the person, out of frustration, haphazadly increases his/her amphetemine intake. Doing so might put them at greater risk of Serotonin Syndrome.

Hope it works out for DD and mom as well

[wifeandmom]

Thank you Aquablue. DD had a bad time with Lexapro (made her groggy, lethargic, etc.) so hopefully I'll be better educated to recognize problems earlier this time.

[hollywood]

but doesn't the grogginess go away after the body adjusts.... I am back to my negative , circular thoughts caused by adhd depression . I was on wellbutrin and it helped but I had that whole memory problem that everybody talks about regarding wellbutrin. I would have stuck it out on the wellbutrin because sometimes I felt fine on it but other times I'd just stare off blankly and thats just not me. I'm not down and out depressed but I'm down. I have the worry thoughts that stem from depressive boredom, I heard lex can help but I'm too much of a wuss to try it...

[wifeandmom]

DD never really got over the drowsiness on Lexipro. She was on 5 mg for a month then titrated up to 10 mg and was on that about 6 weeks if I remember. About that time, I found out she was sleeping all through a couple of her classes!! A teacher finally made a snide remark during a meeting to discuss accommodations. (as in, "She'd be passing my class if she didn't sleep through it.") It would have been nice if someone had mentioned it in reply to one of the weekly emails I sent to every teacher requesting an update on DD's assignments, upcoming projects, etc.

We just started week 2 on Prozac Weekly today. I haven't noticed much positive or negative yet, but didn't really expect anything the first week. It's my understanding that there's likely to be a reduction in anxiety before a reduction in depression symptoms. DD's a ruminator, so hopefully some of that will dissipate in the next few weeks.

All of the references I've found to Prozac Weekly indicate it's used as a maintenance treatment after using the daily release until remission. I hope we see some relief using it this way.

[wifeandmom]

Not too impressed with the results of Prozac Weekly so far, but still plugging along.

Week 1: No obvious changes, positive or negative

Week 2: DD skipped some of her classes three different days (she hasn't skipped since last fall), has started obsessively texting a boy who isn't her steady boyfriend, failed to turn in paperwork the school guidance counselor needed, even though he sent for her during class four different times, didn't pick up cap and gown during multi-day issuing at school. Dad read her the riot act and told her to stop skipping.

Week 3: (Two days in) DD hasn't skipped this week, but the odd texting (sexting I think) behavior remains unabated. Thanks to missing class last week, DD is now failing yet another class required for graduation. Asked her today "Do you plan on graduating this spring?" She said, "That's such a stupid question, I'm not even going to answer it." I immediately called the Pdoc and we're going in Thursday so I can ask him what this is . . . worsening of depression, side effects of Prozac????

Anyone have any thoughts?

[obsessive]

I started Prozac today. Just switched from Celexa. My doc said initial side effects of Prozac can be anxiety and irritability... SSRI's will take 4-6 weeks to kick in to full effect and smooth out in the brain. You're going to have to be patient with it.

My doc prescribed me with 2 weeks worth of Ativan for the anxiety side-effect. Talk to your doc about something like this. It's a temporary thing as it is highly addictive, but it is a good way to get around the initial stages.

Also, how sure are you DD has not been skipping daily doses? That can really **** things up.

[wifeandmom]

Obsessive, did you mean skipping Prozac or Adderall? DD only takes the Prozac once a week. (The half-life is apparently about 9 days.) We set it up for Sunday administrations in early afternoon. She's always home then and I've witnessed her taking it all three times. Last Sunday she even remembered to come in to the kitchen to get it herself. That was a big deal, since she usually forgets her PM booster of Adderall.

The info I've read about the 2D6 enzyme indicates that it processes both the Prozac and the Adderall. Since the Prozac is already hanging around (thanks to the long half life), the Adderall MIGHT build up. To test that possibility, I adjusted her Adderall doses this week. On Monday I gave her the normal 40 mg Adderall in the morning. Tuesday I gave her 20 mg and Wednesday I gave her none. I asked her Wednesday afternoon if she was aware she hadn't taken her Addy and she wasnt. That's unusual for her, because she's complained in the past about not having the meds on board when she hasn't taken them.

The pdoc didn't seem terribly concerned about her weird behavior the second week, since she seemed to have gotten a handle on most of it by the time we saw him. (other than the cheating on the long-term bf). He also said that her Prozac dose was so low, interaction shouldn't be a problem.

I hope things improve soon. :\

[obsessive]

Well I can't speak for the doctor who is prescribing DD her meds but I always assumed when one is on anti-depressants he/she is to take a dose daily. I take Prozac daily, but then again I have OCD. Again, I'm sure your doc knows better, but I don't even see the benefit of taking a pill once a week. How is the brain supposed to stabilize? There is no consistency.

[wifeandmom]

Prozac Weekly is an extended release form that's designed to be taken once every seven days. I had never heard of it until the Pdoc prescribed it for DD, even though it received FDA approval in 2001. Here's some info:

http://pn.psychiatryonline.org/cgi/content/full/36/7/33

[obsessive]

Fair enough. Well if Proz Weekly is anything like regular Prozac let me tell you from personal experience that the side-effects include mad mood swings and terrible anxiety. I've been flipping emotions about every hour for the last 5 days and have felt like complete trash. Take it for it's worth. Good luck with DD.

[wifeandmom]

DONE!! NO MORE!!! The past month has been a steady slide into the pits. DD still hasn't gotten caught up on school work, is skipping classes again, has basically broken up with her boyfriend to carry on with the other guy, stays up until about 2:00 a.m. (and has to get up around 6:00 for school). Last night she was up literally all night. Had a big uncontrollable crying spell, her ex called me at 2:30 in the morning because he had been conversing with her by text and became worried that she would take an overdose of something. Lots of trauma and drama.

I had tried to call her pdoc Thursday to tell him she was having school and relationship issues still, but couldn't get through. I sent him an email while I was on hold with his office, just to cover my bases. I still haven't heard back.

However, I'm not giving my child another dose of this med. I'll try again to get through to the pdoc on Monday. That will put her a day late on her prescribed dose, but since she only takes it once a week, I don't think she'll experience horrible withdrawal effects so soon.

I know there are many who are satisfied with Prozac, but it sure isn't working for DD.

[obsessive]

I am yet to see any benefit as well. I'm only on day 10 but I feel like shooting myself in the ****in skull.

[wifeandmom]

Obsessive, do you have anyone in your life to help you monitor what's going on? DD doesn't seem to "get" that her behavior isn't appropriate. If she were an adult living alone, there's no telling how things might have played out.

BTW, I received a reply from her pdoc today. He said that because of the long half-life of Prozac, DD shouldn't have problems just quitting cold turkey. I know withdrawal issues are a highly individualized thing, so we'll see how it goes.

I bought a book yesterday called "Potatoes Not Prozac" that preaches the high protein breakfast, three meals, vitamins, etc. All the stuff we know is good for ADHD. The author's belief is that many people are sugar sensitive and their mood problems are driven by blood sugar level changes. BTW, the title refers to the eating plan component of eating a potato before bed so tryptaphan can be converted to seratonin.