Posted by utopizen on October 12, 2004, at 22:36:19
In reply to Re: Cymbalta, posted by invisiblemanpa on October 12, 2004, at 17:51:49
Sorry- this is long-- but it's informative to ANYONE who wants to feel like they're getting the most out of their treatment, and advise anyone to read it.
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You have a very healthy attitude about your treatment management. It's refreshing to hear-- so many of us (or at least me) often just treat these meds like they're band-aids for our brain.I'm trying to get away from this, and just scheduled my CBT appointment today and will start seeing this therapist regularly (biweekly) for the next few months.
I'm glad you find hope in Cymbalta. Don't be afraid to work with your doc to agressively up the dose-- just a few days of 30-40mg is all that is really needed before goign to the target dose of 60mg, IMHO through the literature I've read.
The 60mg dose should provide you with some relief after 1-2 weeks of being on it, and full relief at some time in the 4th week or slightly later. As always, it could take a couple of months before you notice a thing, even if you're only counting from the first day you began 60mg (the therapeutic dose).
But don't despair. You're on Klonopin already, which will help you chill while you wait for Cymbalta to do its thing. And even if the 60mg target dose doesn't spell relief after a month, keep in mind many do take up to 120mg, leaving you room for even further improvement and hope.
And of course, if you persist with your symptoms at a very high dose of Cymbalta, the usual augmenting meds are always available for you, with cheap co-pays. Lamictal, Lithium, and an atypical antipsychotic can really help depressives (bipolar or not) receive more relief when they only find partial relief from a single antidepressant. And if those fail, there's always Lexapro you can add on to the Cymbalta, and see how that goes. But all of these are just ideas, and I'm not a doc, I'm just going by common treatment-resistant treatment regimens that are published in psychiatric journals. Listen to your doc, not me.
The important thing is-- especially if you plan on a time where you reduce your Klonopin to prn (as needed) use- is to continue with Cognitive Behavioral Therapy.
But do keep in mind that some studies indicate antidepressants are sometimes aided by Klonopin use, although reports of depression also exist.
Don't expect Cymbalta to be a miracle-- you may find it will help somewhat, and Klonopin use isn't really anything to shy away from if you find it helps and aren't abusing it. It does have discontinuation issues, but this isn't much of an issue- if your doc has been practicing medicine at some point after 1957, he knows how to wean you off it without risking a seizure.
Klonopin, unlike Xanax, IS NOT physically addictive. It's only psychologically habit-forming, and being someone who took 1 mg 3x/day, I can tell you I also forgot doses now and then and never once felt any need to increase my dose beyond what was directed.
Cymbalta, and CBT, and exercise, and schedule-planning and other behavioral strategies, will help you. You sound like a very sound and grounded person, and there's no reason to think you won't find relief between your meds and therapy.
Just one thing, though- I advise everyone with depression/anxiety to make a log at least once a week, it doesn't need to take 2 minutes. List your major concerns/stresses, your mood on a scale of 1 to 10, and honestly ask yourself if you're doing what's necessary to control your stress and stay on task with your life. Work with your therapist on how to cope with things you feel are out of your "control," have your doc and therapist allowed to talk to one another, and arrange appointments regularly with each.
And I can't stress this enough: call your doc weekly, especially if you AREN'T noticing any progress. Yes, these meds take weeks, but they can be adjusted now and then to speed up your treatment. DON'T rely on meetings alone to confont your concerns. Call ahead a few days prior to each appointment tp leave a short message to your doctor and therapist listing your top concerns, ideas for med changes (if any) and explain whether you feel you are worsening, progressing, or staying the same.
If you meet monthly with your care provider, but feel you need more agressive management of your treatment, bring this up.
Ask if you can see your provider more frequently, or at the very least have brief phone updates each week and have your providers talk to one another between appointments. Especially if your pdoc won't agree to this simple request, ask if he can refer you to a colleague that will.
Waiting monthly just to add a little to your dose or something is wasting your appointments-- incremental dose adjustments should be handled in-between appointments unless you have weekly meetings.
poster:utopizen
thread:401647
URL: http://www.dr-bob.org/babble/20041012/msgs/402440.html