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 Post subject: Prozac and Suboxone
PostPosted: Sat May 14, 2016 11:00 pm 
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Hello. I am new to this site however I am not new to suboxone. Unfortunately I've been on it for almost 6 years. I have tapered myself down over the past 3 years from 24 MG per day (I know now that this was way to high a dose) to between 1-2 MG per day. Rrally trying to get off. Its time.

Over the last year I have been experiencing severe depression despite having many good positive things going on in my life. I feel hopeless and it takes every ounce of energy in my body to simply get out of bed each day for work and to care for myself and my 2 kids. When my kids are not here I crawl into my bed and will stay there until I'm forced to function again (sometimes two days straight when my kids are with their dad) I don't remember ever feeling this bad.

I've struggled with depression on and off since I was a teen and have been on Wellbutrin (on and off) for years now. It doesn't seem to help me anymore. I guess I've come full circle with it or hit a plateau? IDK


Two days ago I finally dragged myself to the doctor (although I really don't like or trust them). I broke down sobbing telling her how scared I was and how low I have been feeling. I explained to her how nervous new medications made me and asked her to please prescribe me Prozac as many years before I had used it for depression and it had worked very well with very little side effects. 5he Wellbutrin is for the dopamine and I thought perhaps it was now a seritonin issue?

She agreed to do so and for the first time...in a long tine...I felt hopeful. Relief.

This hopefulness was crushed when she realized that she could not prescribe me the Prozac due to the drug interactions with the suboxone. She said the combination could cause heart issues? ( I'm 42, not over weight,and do not smoke or drink. I'm in good physical condition )

She instead prescribed Cymbalta which scares the hell out of me. The information I read along with the withdrawal from Cymbalta is terrifying to me. I'm so lost.

I scoured the Internet looking for information regarding this interaction between Prozac and suboxone but can't find a thing about it.

Anyone else take this combination (subs and prozac)? Anyone else hear or experience severe side effects from this combination?
Anyone have any experience with Cymbalta (I did read some on here)

Any information or ideas are welcomed and very much appreciated.

Linda


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 Post subject: Re: Prozac and Suboxone
PostPosted: Sat May 14, 2016 11:45 pm 
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Oh for Pete's sake... that's aimed at your doc, not at you--- that's ridiculous! Fluoxetine (the generic name) is perfect fine to give to someone on buprenorphine(!) I swear, I sometimes wonder if doctors are getting less and less intelligent... which is a horrible snobby thing to say, but...

A couple cases of serotonin syndrome have been reported that may have been caused by opioids, including buprenorphine. I don't believe it myself; the evidence is weak, and makes little or no sense from a neurochemical perspective. The interaction between fluoxetine and buprenorphine consists of an increase chance of serotonin syndrome. But even if buprenorphine CAN contribute to serotonin syndrome, it is very rare. I prescribe buprenorphine and SSRI's routinely; most of my buprenorphine patients take them, frankly. And serotonin syndrome shows up as irritability, then may diarrhea, and then if on a very high dose of multiple serotonin meds, a person could theoretically have a seizure. I didn't see a serious case of serotonin syndrome through my entire psych residency, or during my past 12 years as a psychiatrist. It just doesn't happen often--- and if it happens, it is not a big deal.

So maybe your doc is just super, super careful... but the problem with that conclusion is that ALL SSRI's and SNRI's (including Cymbalta) have the same interaction warning! In fact, the warning for Cymbalta goes further because of the lowering of the seizure threshold by that med. Here is the warning from epocrates for fluoxetine/buprenorphine:

Monitor closely, especially during tx start and after dose incr.: combo may incr. risk of serotonin syndrome (additive effects)

And here is the warning for Cymbalta (duloxetine) and buprenorphine:

monitor closely, especially during tx start and after dose incr.: combo may incr. risk of serotonin syndrome, seizures (additive effects)

But listen, honestly--- both meds are fine. But consider seeing a psychiatrist. The proper approach for you from what you said would be to use an activating antidepressant--- either prozac or cymbalta would be fine--- and the perhaps augment temporarily with a small dose of Abilify-- 2-5 mg, up to a max of 10 mg. Of course there is probably another warning when you do that. These days, almost every medication combination will have warnings. The lower warnings though just recommend watching for problems. In any case where there is a real risk-- say a 2% risk of something that could cause injury or hospitalization-- the warnings are going to be much greater, with comments like 'do not use, seek alternative'. This is just the result of a litigious society and fearful doctors. I don't know how any of these docs think patients survived medicine before computers, back when we had to remember all of the important things, rather than look them up on our phones!!

I do hope you get on the right medication, and feel better soon. Please see the other recent thread in the recent posts column about the need to get out of bed, ESPECIALLY when you don't feel like you can. You simply CANNOT stay in bed, just like you can't go sit in a bar all afternoon. There are things to do-- and you will feel better if you drag yourself through them. Bed is NOT an option. KEEP MOVING.


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 Post subject: Re: Prozac and Suboxone
PostPosted: Mon May 16, 2016 6:51 pm 
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Hello...? (stupid doctor) I have been on fluoxetine for around 10 years. My sub doctor prescribes it to me. Your doctor is stupid and most likely just trying to minimize her own risk. Quite cowardly of her!

Amy

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 Post subject: Re: Prozac and Suboxone
PostPosted: Tue May 17, 2016 6:32 pm 
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I take 20mg Prozac daily along with 8mg suboxone and 50mg vyvanse. I have not had any negative side effects from this combo except for the vyvanse making me anxious (I think dose is too high) and mild sexual dysfunction.


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 Post subject: Re: Prozac and Suboxone
PostPosted: Thu Jul 21, 2016 10:02 am 
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Both are fine. In my case, Prozac isn't effective at all in treating my depressive symptoms. Cymbalta works a lot better. But I'm doing quite well at the moment on Brintellix. However I've yet to find an antidepressant that actually helps me when I get severely depressed, which usually happens every year around April for 1 to 2 months. Have recently conceded that maybe it's something I'm just going to have to live with.

But yeah. Prozac is fine on Suboxone in my experience. But equally so, you shouldn't fear Cymbalta.


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