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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by grumpii on August 28, 2007, at 11:29:08
I have major depressive d/o and get migraines weekly. The neuro I've been seeing has tried a combo of Topamax and Zanaflex w/o success. The Topamax caused hair loss so I stopped. My T has recently put me on 75mg Effexor w/ 60mg Cymbalta. Does anyone have any input on this combo, the effectiveness of it for depression/anxiety and/or migraines? Any info would be appreciated.
Posted by Phillipa on August 28, 2007, at 11:36:32
In reply to Effexor/Cymbalta combo, posted by grumpii on August 28, 2007, at 11:29:08
Are they compatible both SNRI's and if you google drug checker you can check. Bet a lot of comments on this. Good luck to you. Phillipa
Posted by Racer on August 28, 2007, at 12:49:02
In reply to Effexor/Cymbalta combo, posted by grumpii on August 28, 2007, at 11:29:08
That combination sounds downright dangerous to me. At 75mg, Effexor is acting as an SSRI, and Cymbalta is an SNRI, so I would be worried about serotonin syndrome.
When you say your T put you on this, does that mean that you're getting therapy from a psychiatrist? Usually, "T" refers to psychotherapist, and usually that's either a psychologist (PhD), or master's level therapist, not an MD, so they usually can't prescribe medication.
As far as effectiveness goes, mileage varies -- you'd have to try any drug to see if it will help you. In general, though, Cymbalta does help with pain, and I'd expect it to be a pretty good choice for depression/anxiety/migraines. Adding Effexor, though -- I'm not going to offer my opinion there, but will say I think it's in your best interest to ask your doctor what he/she was thinking when combining those two drugs. It's worth calling now, too, rather than waiting until your next appointment.
By the way, did your doctor warn you about the discontinuation problems with Effexor?
Good luck
Posted by med_empowered on August 28, 2007, at 13:43:02
In reply to Re: Effexor/Cymbalta combo » grumpii, posted by Racer on August 28, 2007, at 12:49:02
that combo sounds not OK. I'd say go with one or the other. Cymbalta above 60mgs/ day doesn't have much benefit versus 60mgs/day; Effexor, on the other hand, supposedly can show benefit with super-high doses (like 500+mgs/day). Personally I'd drop effexor and do 60mgs/day cymbalta.
Posted by grumpii on August 28, 2007, at 13:55:46
In reply to Re: Effexor/Cymbalta combo » grumpii, posted by Racer on August 28, 2007, at 12:49:02
Wow, I just read about Serotonin Syndrome and I've been on Effexor 300mg and taking every triptan known w/o relief and my neuro doc. knows about the effexor and said nothing???
It was my doctor that works together w/ my T and has for many years that added the Cymbalta and told me to decrease the effexor to 75mg by dropping 75mg off each week so 225mg this week, then 150 and then 75 but to continue 75mg. They also added Deplin 7.5 trying anything to help....
I did call but haven't heard back yet.
Posted by Phillipa on August 28, 2007, at 20:27:37
In reply to ummm...why?, posted by med_empowered on August 28, 2007, at 13:43:02
Hence why I left the pdoc here he wanted me on cymbalta l20mg in four weeks. When saying manufacturer says above 60 works no better he said he'd found that not to be true. Didn't like this man at all. Phillipa
Posted by sam123 on August 28, 2007, at 22:45:20
In reply to Re: Effexor/Cymbalta combo » Racer, posted by grumpii on August 28, 2007, at 13:55:46
> Wow, I just read about Serotonin Syndrome and I've been on Effexor 300mg and taking every triptan known w/o relief and my neuro doc. knows about the effexor and said nothing???
>
It depends on what you mean by triptan. In the class of drugs that includes imitrex, there are some that can be taken with AD's. Serotonin Syndrome (SS) is pretty rare, so much so as it is not well understood. This also means it is not always recognized when it happens. Often it is an additional med that causes SS, true synthetic opioids like Demerol, Ultram and DMX + an AD are often common in the reports I have seen. Non and semisynthetic opioids seem OK. A MAOI + AD seems to be a cause of some reports of SS. MAOI + demerol or DMX is another suspected cause of some cases of SS. Abuse of DMX is common and I have seen quite a few reports of SS when the person is also taking an AD.I have taken Effexor with other AD's; it must be done with care. Effexor is a powerful RI of Serotonin, adding another AD can change metabolism such that you get large (several times to exponential) increases of levels of one, the other, or both AD's in the body. A good way to cause SS. A good doc and low and slow were key for me to avoid a drug-drug problem. Some have reported SS from use of a single AD; it seems
this happens on starting an AD and not after you have been taking an AD for a while, unless you add another med that can cause SS.Effexor/Cymbalta combo...yuck. Just my personal opinion. Effexor is a powerful RI of Serotonin and a moderate RI of norephinepherine. Cymbalta more potently blocks serotonin and norephinepherine transporters in vitro and in vivo than venlafaxine. (see note 1). So one or the other, but not both. better to just take more of one, if tolerated, to get the same effect of taking two.
I love norephinepherine RI's but many do not. Increased heart rate and blood pressure, sweating,
anxiety, and urinary hesitation (Note 2) are common side effects. I would argue they are not side effects but primary effects as all use norephinepherine in some way.Note 1:
Bymaster FP, Dreshfield-Ahmad LJ, Threlkeld PG, Shaw JL, Thompson L, Nelson DL, Hemrick-Luecke SK, Wong DT. "Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors". Neuropsychopharmacology. 2001 Dec;25(6):871-80Note 2:
Urinary Side Effects of Duloxetine in the Treatment of Depression and Stress Urinary Incontinence
Posted by CareBear04 on August 30, 2007, at 22:11:40
In reply to Effexor/Cymbalta combo, posted by grumpii on August 28, 2007, at 11:29:08
Like everyone else, I would recommend just one of the combo since they essentially work on the same neuroreceptors. In my experience, Cymbalta was much more effective for me than Effexor. I took 150mg of Effexor XR for about six months, but maybe that wasn't a high enough dose to get the norepinephrine effect. On the other hand, I felt the full effect of Cymbalta at 60mg a day. I've been on countless combos of serotonergic meds without disaster, and I think Serotonin Syndrome might be a zebra-type scare.
Doctors that I've talked to have spoken highly about Cymbalta's effect on chronic pain. Since depression and migraine are comorbid and being depressed can make you more susceptible to migraines, I would suggest whatever regimen best treats your mood problems. As for migraine prophylaxis, have you tried aspirin? I know it's probably the most basic treatment out there, but since platelets activate and aggregate more readily in migraineurs and aspirin inhibits platelet function, some people find it very effective. But as for Effexor AND Cymbalta, I would stick with one.
CB
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