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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by fauna on October 10, 2005, at 18:26:53
Hello to all,
I’m new to the forum but certainly not new to depression and anxiety. I’m 43 and have been dealing with depression (and occasional anxiety-panic disorder) since I was about 14. My kind of depression is the endogenous type. I can trace depression all through my paternal bloodline like breadcrumbs! So it is quite clear that I will never be off of AD’s for any length of time without sliding into the depths of suicidally-severe depression. That said, I have also been on just about every AD ever made. From TC’s to SSRI’s and now an SNRI- Cymbalta. I have trouble with “poop-out” syndrome or rashes. And this is why I need someone’s — anyone’s advice.
I was well maintained on Lexapro 10mg daily for over a year. I experienced minimal to no SE’s from Lex either. Then for some stupid reason I felt that maybe I could go off of it and maybe be okay. (I know, bad mistake!) But I was okay for about 4 months. Felt great, functioned well. However, at one point I recognized the decline beginning and restarted my Lex at 5mg and was about to go to 10mg when I began experiencing a lot of tension and anxiousness. Near panic attack strength. This floored me since I had not had problems with anxiety for almost 20 years! And hadn’t experienced this SE with Lex in the past nor with Zoloft or Paxil. I went to a new pdoc (limited choices here) and he felt that I should give Cymbalta a try to boost my norepinephrine a little more than my serotonin. I went one week at the 30mg dose with no effect whatsoever, then increased about 4 days ago to 60mg daily. I now have some very strange and disturbing feelings (SE’s?) going on. Still no improvement in my depression but major trouble focusing on anything (visually and cognitively), significant drowsiness, muscle tension, headaches, distractibility, agitation, and a dull-like feeling in my head— kind of like there is a rock sitting on my forehead between my eyes! People at work say I have a wide-eyed, glazed-out appearence and this seems to fit what I sense as well. It seems my brain is just not processing info properly and all I want to do is sit and stare at a wall! I have called my pdoc’s nurse and have another appt in 2 days and I told her that I was cutting back to 30mg a day till then. She agreed.
Do these symptoms make any sense at all to someone who has been on an SNRI? Is this common with Cymbalta at a 60mg dose? If these symptoms are just the start up kind, do they generally subside after a while and maybe I should just give it a little more time? I’m just wondering if I should push to have it dc’d and go back to Lex or try Zoloft again and ride out any anxiety symptoms (if they reoccur) since both have worked well for me in the past. I do have Xanax .25mg to .50mg as needed but I hate taking it for fear of dependency. BTW, I’m sorry to post such a long message and to trouble the board with my questions, but I really can’t seem to process a rational decision at this time by myself. I would GREATLY appreciate any words of wisdom!
Posted by Phillipa on October 10, 2005, at 20:50:57
In reply to Cymbalta and other SNRI side effects?, posted by fauna on October 10, 2005, at 18:26:53
Why not use the xanax or klonopin? At least until you see your doc. Interestingly I tried cymbalta a year ago and the only feeling was no aches or pains didn't touch anxiety or depression. Fondly, Phillipa
Posted by Emily Elizabeth on October 10, 2005, at 21:41:42
In reply to Cymbalta and other SNRI side effects?, posted by fauna on October 10, 2005, at 18:26:53
Have you tried any combos? Perhaps augmenting an SSRI or TCA? Using something like lamictal or lithium?
Best,
EE
Posted by theo on October 10, 2005, at 22:53:13
In reply to Cymbalta and other SNRI side effects?, posted by fauna on October 10, 2005, at 18:26:53
I've had a lot of problems like you mentioned with Cymbalta. Tried 30mg (15 days) which was to much so went to 20mg (14 days). Still felt bad and dropped to 10mg (had to divide the pellets).
Now that I'm on 10mg, I actually feel pretty damn good, only problem is they don't make 10mg pills or even liquid. I'll probably go ahead and stop it but would probably hang on with 10mg if it was available.
Posted by Cairo on October 12, 2005, at 20:53:06
In reply to Cymbalta and other SNRI side effects?, posted by fauna on October 10, 2005, at 18:26:53
Remember that the various receptors reset after medication use (or med vacation), so you might not get the same response you had last time. Also, when you increased the dose, you literally doubled it. You might have tried upping it by only 5mg at a time. Very simple to open the capsule up, count total number of pellets, then swallow, being careful not to chew or break, the number of pellets you need.
I couldn't handle Cymbalta at doses higher than 5mg; any more than that and I had all your symptoms plus more. But don't extrapolate too much from anyone else's situation. Everyone is different.
Cairo
> Hello to all,
> I’m new to the forum but certainly not new to depression and anxiety. I’m 43 and have been dealing with depression (and occasional anxiety-panic disorder) since I was about 14. My kind of depression is the endogenous type. I can trace depression all through my paternal bloodline like breadcrumbs! So it is quite clear that I will never be off of AD’s for any length of time without sliding into the depths of suicidally-severe depression. That said, I have also been on just about every AD ever made. From TC’s to SSRI’s and now an SNRI- Cymbalta. I have trouble with “poop-out” syndrome or rashes. And this is why I need someone’s — anyone’s advice.
> I was well maintained on Lexapro 10mg daily for over a year. I experienced minimal to no SE’s from Lex either. Then for some stupid reason I felt that maybe I could go off of it and maybe be okay. (I know, bad mistake!) But I was okay for about 4 months. Felt great, functioned well. However, at one point I recognized the decline beginning and restarted my Lex at 5mg and was about to go to 10mg when I began experiencing a lot of tension and anxiousness. Near panic attack strength. This floored me since I had not had problems with anxiety for almost 20 years! And hadn’t experienced this SE with Lex in the past nor with Zoloft or Paxil. I went to a new pdoc (limited choices here) and he felt that I should give Cymbalta a try to boost my norepinephrine a little more than my serotonin. I went one week at the 30mg dose with no effect whatsoever, then increased about 4 days ago to 60mg daily. I now have some very strange and disturbing feelings (SE’s?) going on. Still no improvement in my depression but major trouble focusing on anything (visually and cognitively), significant drowsiness, muscle tension, headaches, distractibility, agitation, and a dull-like feeling in my head— kind of like there is a rock sitting on my forehead between my eyes! People at work say I have a wide-eyed, glazed-out appearence and this seems to fit what I sense as well. It seems my brain is just not processing info properly and all I want to do is sit and stare at a wall! I have called my pdoc’s nurse and have another appt in 2 days and I told her that I was cutting back to 30mg a day till then. She agreed.
> Do these symptoms make any sense at all to someone who has been on an SNRI? Is this common with Cymbalta at a 60mg dose? If these symptoms are just the start up kind, do they generally subside after a while and maybe I should just give it a little more time? I’m just wondering if I should push to have it dc’d and go back to Lex or try Zoloft again and ride out any anxiety symptoms (if they reoccur) since both have worked well for me in the past. I do have Xanax .25mg to .50mg as needed but I hate taking it for fear of dependency. BTW, I’m sorry to post such a long message and to trouble the board with my questions, but I really can’t seem to process a rational decision at this time by myself. I would GREATLY appreciate any words of wisdom!
>
Posted by fauna on October 13, 2005, at 9:31:44
In reply to Re: Cymbalta and other SNRI side effects?, posted by Cairo on October 12, 2005, at 20:53:06
Thank you to all for your responses! I saw my pdoc yesterday and he now feels that I'm probably a bipolar II-- and in retrospect it really does make sense. I've had thoughts along that line for a year or so now. But it was still hard hearing it from the pdoc "officially" you know?
Anyway...for now we are leaving the Cymbalta at 30mg daily and he is slowly adding Abilify to it to check my reaction. Starting at a half tab (2.5mg) for 3 days then going to a whole tab. If it works then he says he will probably switch me to depakote or lamictal-- either alone or in combo with an SSRI because I still lean way too much toward depression rather than hypomania. Took the first dose of 2.5mg last night but didn't sleep worth a darn all night! Still anxious and on "overload" cognitively but I am now taking the Xanax once or twice a day to calm things down some and it does help. Still not convinced that I want to continue the Cymbalta though. I don't like how it makes me feel but overall my depresive S/S seem a "little" better than last week. But I also know myself well enough to realize I HAVE to be on an AD too.
It's just hard being in that "guinea pig" stage again! Tweaking this and tweaking that. But I will keep rolling with it! Thank you again for the responses and support! Will let you know how it goes! Best of everything to all!
Posted by SLS on October 13, 2005, at 11:28:28
In reply to Re: Cymbalta and other SNRI side effects?, posted by fauna on October 13, 2005, at 9:31:44
Hi.
Cairo makes an important point about receptors and other neural processes resetting themselves when a drug is removed from the system. Many people do not respond as well to the same antidepressant once it is reintroduced. However, they often do go on to find another drug that will work well.
Regarding Lexapro, at what point did you experience the anxiety, and for how long? Anxiety is a well known startup side effect of Lexapro that usually disappears in the third week of treatment. Perhaps you would still have responded well to Lexapro if you had waited a bit longer.
Good luck on finding a new regime.
- Scott
Posted by theo on October 13, 2005, at 23:32:17
In reply to Re: Cymbalta and other SNRI side effects?, posted by fauna on October 13, 2005, at 9:31:44
> Anyway...for now we are leaving the Cymbalta at 30mg daily and he is slowly adding Abilify to it to check my reaction. Starting at a half tab (2.5mg) for 3 days then going to a whole tab.
My doc just today prescribed me 2.5mg of Abilify. I'm scared to take it! Can you give me any input so far? Do you take it at night?
Posted by fauna on October 14, 2005, at 8:42:14
In reply to Re: Cymbalta and other SNRI side effects? » fauna, posted by theo on October 13, 2005, at 23:32:17
I took the Abilify at night per my pdoc's instruction along with my Cymbalta 30mg. I didn't sleep well at all that night and I was very nauseated- but just briefly- the next morning. I took it again last night along with my Cymbalta but added .25mg of Xanax and I slept pretty well. No nausea this morning either. I've always had problems with sleep plus the Cymbalta is also pretty new (2 weeks) so right now I can't really say if I've had any S/E from the Abilify itself. I do know that the next day after I took that first dose, I was much calmer in my thoughts and less internally focused! Now that was shock! But a GOOD one! Guess my pdoc is really onto something here with the BP II idea.
I go up to 5mg daily on the Abilify this weekend so maybe I will have more to share at that time as to what (if anything) I experience with it. Please keep me updated on how you do with it if you decide to take it! Hope all goes well! Take care!
Posted by theo on October 15, 2005, at 15:36:16
In reply to Re: Cymbalta and other SNRI side effects? » theo, posted by fauna on October 14, 2005, at 8:42:14
I do know that the next day after I took that first dose, I was much calmer in my thoughts and less internally focused!
What do you mean when you said the Abilify helps you be "less internally focused?"
I came down with the flu and am taking Z-Pak, Sudafed+Zyrtec, so am holding off on starting my Abilify until Tuesday, but will let you know. Also, did you move up to 5mg? Let me know how it goes. I'm also down to about 20 pellets of Cymbalta on my discontinuation and will stop it completely after tonights dose, so I will be giving Abilify a true test by itself.
Posted by fauna on October 16, 2005, at 13:46:22
In reply to Re: Cymbalta and other SNRI side effects? » fauna, posted by theo on October 15, 2005, at 15:36:16
> What do you mean when you said the Abilify helps you be "less internally focused?"
Well I have a tendency to really scrutinize how I'm feeling especially when I'm in a depressive phase. I imagine a lot of somatic physical complaints (hypochondria). And either that process or in combo with what my pdoc now feels is my BPII affecting me (constant rushing thoughts I'm trying to process) is what I mean by "internally focused". Just a state of "hypervigilence". Not paranoia per say, just not calm and relaxed enough to let go and enjoy what's going on around me? Hope this makes sense!
> Also, did you move up to 5mg?
Not yet. I still had a half tab last night and I didn't want to "waste" it. Will take the whole 5mg tonight. Will let you know how it goes.
>I'm also down to about 20 pellets of Cymbalta on my discontinuation and will stop it completely after tonights dose, so I will be giving Abilify a true test by itself.
I too am working myself down off of the Cymbalta (divided a 30mg last night). My pdoc doesn't know that yet but he will Tuesday. I have never done well on anything that even remotely affects norepinephrine and I WILL NOT take this medication anymore! Spins me up too much and I don't need that on top of dealing with being newly re-Dx'd as BPII. I'm going back to Lexapro or maybe Zoloft one way or another. Why are you dc'ing the Cymbalta?
Posted by theo on October 16, 2005, at 22:28:23
In reply to Re: Cymbalta and other SNRI side effects?, posted by fauna on October 16, 2005, at 13:46:22
Why are you dc'ing the Cymbalta?
>
>
>Because it didn't do much but give me a headache and nausea, not a very effective med for me. I also felt very distant, not at all myself. I'm trying Abilify in a day or so, still pumped full of decongestants and Z-Pak, and if it doesn't do the trick, I may just try Concerta again. I hate to resort to a stim, but at least I feel like myself, and not like I'm on something.
This is the end of the thread.
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