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Dr. Bob is Robert Hsiung, MD,
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Posted by owensmar on September 1, 2004, at 15:03:00
In reply to Re: Why is your doctor refusing Cymbalta? » theo, posted by hope4best on September 1, 2004, at 8:18:22
I've seen this advice posted elsewhere on this board. If you don't have other problems and other meds to have to balance, maybe you could try asking for a trial of Cymbalta from a GP while you look for another pdoc. Most GP's I've been to are less likely to get their feathers ruffled by patient suggestions. Not as much ego, perhaps?
I've also discovered that if there is something in particular you want the doctor to recognize, you can't go at it directly. You have to work it so that they think they thought of it themselves.
For example, if you think you have fibromyalgia, don't go in and say "I think I have fibromyalgia." Go in and describe the symptoms you are having and let the doc come up with the dx.
Good luck
Marsha
Posted by SLS on September 1, 2004, at 20:03:20
In reply to Re: Cymbalta (duloxetine) - report -To Scott (SLS), posted by Denise1904 on September 1, 2004, at 11:25:13
Hi Denise.
> How long are you going to stay on 60mg,Probably for three weeks if there is no improvement.
> do you intend going up to the max dose of 80mg and if so for how long?
I think my doctor and I are looking at 120mg as a maximum. Many of the studies used this as one of the dosages tested. It probably makes sense to go to 80mg (40mg b.i.d.) for three weeks before going to 120mg. I guess it will depend upon the degree of antidepressant response and my tolerance of side effects.
- Scott
Posted by Lest on September 2, 2004, at 0:02:46
In reply to Re: Cymbalta (duloxetine) - report -To Scott (SLS) » Denise1904, posted by SLS on September 1, 2004, at 20:03:20
im havin trouble breathing on it, but thats just me, i reacted the same to zoloft, ill let ya know how it goes. peace
Posted by SLS on September 2, 2004, at 8:05:40
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on August 31, 2004, at 7:50:04
9/2/2004
Day 14 (6 days at 30mg; 8 days at 60mg)
60mg (30mg b.i.d.)
I felt some signs of improvement in my depression yesterday. It was slight, but perceptible. I'm not so sure about today. It's still early, though. It is so hard to be patient.
The sleepineness that I had been experiencing was not evident yesterday. No other side effects have emerged.
- Scott
Posted by KaraS on September 2, 2004, at 8:47:23
In reply to Re: Cymbalta (duloxetine) - report -To Scott (SLS), posted by Lest on September 2, 2004, at 0:02:46
> im havin trouble breathing on it, but thats just me, i reacted the same to zoloft, ill let ya know how it goes. peace
That's the way I reacted to Wellbutrin. I've never heard anyone else say that about a medication. It's an awful feeling, isn't it?
Posted by jessie77 on September 2, 2004, at 9:49:55
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 2, 2004, at 8:05:40
> 9/2/2004
>
> Day 14 (6 days at 30mg; 8 days at 60mg)
>
> 60mg (30mg b.i.d.)
>
> I felt some signs of improvement in my depression yesterday. It was slight, but perceptible. I'm not so sure about today. It's still early, though. It is so hard to be patient.
>
> The sleepineness that I had been experiencing was not evident yesterday. No other side effects have emerged.
>
>
> - ScottI have been on Cymbalta for 3 days. The sleepiness is killing me. I feel like I am talking to people and my eyes are literally closing.
Posted by Denise1904 on September 2, 2004, at 12:13:11
In reply to Re: Cymbalta (duloxetine) - report -To Scott (SLS) » Denise1904, posted by SLS on September 1, 2004, at 20:03:20
Hi Scott,
I think if I were you I'd wanna just go straight to 120mg and work my way down, the wait is so torturous but you're doing the right thing and I hope it works for you and if it does I'd like to understand why as I know you've already tried many others.
How did you cope coming off all drugs, that must have been hell? What were the last drugs you were taking?
Wastn't sure whether or not to tell you this but I rang Prof A Young at the Newcastle on Tyne university where they were doing the trials on RU486, he told me that although the drug seemed to help with the psychotic symptoms and mood problems when taken, after about a week the mood deteriorated again although the psychotic symptoms stayed away. That made me feel pretty bad as I was hoping they'd found a replacement for ECT for depression.
Do you have any psychotic symptoms?
Denise
Posted by jrbecker on September 2, 2004, at 12:26:28
In reply to Re: Cymbalta (duloxetine) - day 7, posted by jrbecker on August 30, 2004, at 10:59:27
here's my 2nd report...
still taking 30mg in the morning. as far as side effects, some slight sleepiness throughout the early part of the day and some very mild sleep disruption a few nights. As for the daytime sleepiness, I'd guess that it's gotten about 50% better since I started, so this is hopefully good news for most of you.
I have noticed a gradual improvement of my affect anxiety, and motivation in this last week and a half -- nothing phenomenal but definitely significant.
Dare I up it 40mg? I think the deicision will rest on whether the 20mg tablets will be available to me anytime soon. My main concern in doing this would be any increase in apathy that might go along with it. But so far, I've felt more motivated than compared with my old dose of effexor, so maybe an increase might help rather than hinder my inner drive.
Developing....
> here's my first report...
>
> taking 30mg once daily in the morning. only side effects are some mild somnolence about 3-6 hours after dosing. Some nights, I have experienced a little sleep disruption and initial insomnia on some nights. But I've been able to still make it to the gym, so I can't say that there's been any decrease in my overall enegry level. To my relief, I have not experienced any increase in anxiety or agitation. As Scott mentioned, the drug is rather "clean."
>
> So far, I must admit that this is a welcomed improvement over my prior regimen of Effexor 37.5mg.
>
> I plan to stick with 30mg for a couple more weeks.
>
> I haven't ruled out upping to 40mg (20mg BID) or even decreasing to 20mg. As you might guess, I'm fairly med sensitive.
>
> JB
>
Posted by Lest on September 2, 2004, at 13:17:12
In reply to Re: Cymbalta (duloxetine) - report -To Scott (SLS) » Lest, posted by KaraS on September 2, 2004, at 8:47:23
terrible feeling! people dont realize how blessed we are to be able to breath until youre struggling to get air to your lungs. whats worse is, my dr. believes its anxiety doing it and not zoloft, effexor, or cymbalta. Im sure he wont believe me this time either.
Posted by KaraS on September 2, 2004, at 16:34:27
In reply to kara, posted by Lest on September 2, 2004, at 13:17:12
> terrible feeling! people dont realize how blessed we are to be able to breath until youre struggling to get air to your lungs. whats worse is, my dr. believes its anxiety doing it and not zoloft, effexor, or cymbalta. Im sure he wont believe me this time either.
How frustrating for you! Have you taken any meds that you didn't react that way to? (and if so, does your doctor know that?)
Posted by michael on September 2, 2004, at 16:55:14
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 2, 2004, at 8:05:40
> 9/2/2004
>
> Day 14 (6 days at 30mg; 8 days at 60mg)
>
> 60mg (30mg b.i.d.)
>
> I felt some signs of improvement in my depression yesterday. It was slight, but perceptible. I'm not so sure about today. It's still early, though. It is so hard to be patient.
>
> The sleepineness that I had been experiencing was not evident yesterday. No other side effects have emerged.
>
>
> - ScottHi Scott -
I don't come by here too often these days (at least for the moment...) but I'm keeping my fingers crossed for you with this one!
Hope you got the e-mail I sent a day or two ago... don't know how relevant it'll be, but figured it couldn't hurt to at least pass the info along...
Good Luck!!! Talk to you later,
michael
Posted by 4WD on September 2, 2004, at 18:26:17
In reply to Re: Cymbalta (duloxetine) - report, posted by jessie77 on September 2, 2004, at 9:49:55
> > 9/2/2004
> >
> > Day 14 (6 days at 30mg; 8 days at 60mg)
> >
> > 60mg (30mg b.i.d.)
> >
> > I felt some signs of improvement in my depression yesterday. It was slight, but perceptible. I'm not so sure about today. It's still early, though. It is so hard to be patient.
> >
> > The sleepineness that I had been experiencing was not evident yesterday. No other side effects have emerged.
> >
> >
> > - Scott
>
> I have been on Cymbalta for 3 days. The sleepiness is killing me. I feel like I am talking to people and my eyes are literally
closing.
Are you guys taking Cymbalta in the morning or at night?Marsha
Posted by 4WD on September 2, 2004, at 18:44:09
In reply to Re: Cymbalta (duloxetine) - report, posted by jessie77 on September 2, 2004, at 9:49:55
> > 9/2/2004
> >
> > Day 14 (6 days at 30mg; 8 days at 60mg)
> >
> > 60mg (30mg b.i.d.)
> >
> > I felt some signs of improvement in my depression yesterday. It was slight, but perceptible. I'm not so sure about today. It's still early, though. It is so hard to be patient.
> >
> > The sleepineness that I had been experiencing was not evident yesterday. No other side effects have emerged.
> >
> >
> > - Scott
>
> I have been on Cymbalta for 3 days. The sleepiness is killing me. I feel like I am talking to people and my eyes are literally closing.If you're taking it in the morning and experiencing sleepiness afterward, why not take it at night? I just got my Cymbalta RX and not sure when to take it. Is there some reason for taking it in the morning? My script just says one per day.
Marsha
Posted by Lest on September 2, 2004, at 20:02:37
In reply to Re: kara » Lest, posted by KaraS on September 2, 2004, at 16:34:27
paxil is the only thing im on, wellbutrin gave me sharp heart pains, effexor and zoloft gave me breathing problems, abilify gave me akathesia (restless leg syndrome), geodon made me feel like a zombie (only took it once, went out but had to have my mom pick me up, she said i was slurring my words and i felt like i was goin to die, risperdal made me eat too much and i didnt like the mind state it put me in, cymbalta was my last hope, i took 60 mg but ive had breathing probs for 4 days, im gonna get me breathing back, then try 30 mg to make sure its this drug doing it. Then ill probably try lamictal , if you know anything about this drug let me know, im scared to take something thats so strong it treats epileptic seizures. Im at the end of the road basically.
Posted by KaraS on September 2, 2004, at 23:08:29
In reply to Re: kara, posted by Lest on September 2, 2004, at 20:02:37
> paxil is the only thing im on, wellbutrin gave me sharp heart pains, effexor and zoloft gave me breathing problems, abilify gave me akathesia (restless leg syndrome), geodon made me feel like a zombie (only took it once, went out but had to have my mom pick me up, she said i was slurring my words and i felt like i was goin to die, risperdal made me eat too much and i didnt like the mind state it put me in, cymbalta was my last hope, i took 60 mg but ive had breathing probs for 4 days, im gonna get me breathing back, then try 30 mg to make sure its this drug doing it. Then ill probably try lamictal , if you know anything about this drug let me know, im scared to take something thats so strong it treats epileptic seizures. Im at the end of the road basically.
You definitely sound very drug sensitive. Do you still have problems when you're at lower levels of these meds than other people take? Maybe you should be building up very slowly on things rather than jumping in full force. Other people on this board who are very med sensitive are taking far less than the normal drug levels of various medications.
I don't know anything about Lamictal but plenty of the people on this board do. If you don't get any answers on this thread, I'd post another one with Lamictal in the title.
It does sound like you've tried a lot of things but I think there are still other things to try. There are some good tricyclics (i.e. Nortriptyline, Imipramine) and MAOIS (Parnate, Nardil, Marplan) that people here have had good luck with. The word is that the dietary restrictions are not that bad and many people have had good responses to the MAOIs when nothing else worked for them. I'm not sure what you're looking for in terms of which neurotransmitters you want to target so I'll just throw out a few other things. Have you tried Mirapex, Amisulpride, or even SAM-e or St. John's Wort? (the latter is very effective for some people with minimal side effects). The selegiline patch may be out early next year so that could be a wonderful new option. Don't give up hope yet. You have far too many things left to try.
Again, others on this board know a lot more about these things than I do so I'm sure they could give you more information and other suggestions. I just wanted to let you know that you still have plenty of options.
-K
Posted by flipsactown on September 3, 2004, at 0:33:45
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 2, 2004, at 8:05:40
Hang tough my friend! Patience is a virtue and in your case, a must!
When I switched over to Lexapro from Nardil, I was without an AD for 3 weeks and it took another 6 weeks for Lex to kick in. I knew I had to give the Lex a fair trial before I even thought of quitting. Fortunately, I was able to summon my every ounce of determination to persevere, and in 45 days, I was depression free. It is 3 months later, and I am still unipolar depression free.
I know I am not telling you anything that you don't already know, as I consider you a walking encyclopedia when it comes to AD's.
Hopefully, this AD will be the one that works for you. We are all behind you.
FST
> 9/2/2004
>
> Day 14 (6 days at 30mg; 8 days at 60mg)
>
> 60mg (30mg b.i.d.)
>
> I felt some signs of improvement in my depression yesterday. It was slight, but perceptible. I'm not so sure about today. It's still early, though. It is so hard to be patient.
>
> The sleepineness that I had been experiencing was not evident yesterday. No other side effects have emerged.
>
>
> - Scott
Posted by theo on September 4, 2004, at 7:19:11
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by flipsactown on September 3, 2004, at 0:33:45
Hey Scott, any improvements? I think I've asked you this before, but from the time you've been on Cymbalta, can you compare the "feeling" to another med you've tried?
Even after a couple of weeks on meds, either I feel something totally different or feel something similar, comparable to other AD's.
Does it feel like the onset of Effexor, Prozac, Paxil, Lexapro, etc?
Posted by SLS on September 4, 2004, at 8:05:21
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 2, 2004, at 8:05:40
9/4/2004
Day 16 (6 days at 30mg; 10 days at 60mg)
60mg (30mg b.i.d.)
I can't say that I feel any improvement, but I don't feel worse either. That's positive. On Wednesday, I definitely felt an improvement in depression that is not part of the normal course of my illness. I attribute it to Cymbalta. Unfortunately, most of that has disappeared. If there is anything positive going on, it is difficult to discern, but I believe I still have reason to be optimistic.
Regarding side effects, there is still some mild sleepiness, but it is gradually disappearing. I have noticed a bit of hesitency in urination and perhaps some restricted flow.
Cymbalta still feels very clean. I can't say that it is similar to any of the other drugs mentioned along this thread because I hardly know that I am taking it. Most of the others made themselves known by producing some kind of perceptible cognitive effect. This is producing none. Maybe I'm not taking enough.
- Scott
Posted by pseudonym on September 4, 2004, at 10:40:05
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 4, 2004, at 8:05:21
Hello SLS,
My interest is in Cymbalta, and I would like to know if you can actually distinguish between the effects of all four substances in the CNS (see below). On the surface, it would seem difficult to ascribe benefits/effects to one or the other.
You mentioned that your regimen included Abilify, Lamictal, Namenda, now in addition to Cymbalta. With this combination, you are affecting many neurotransmitters/receptors, including serotonin, noradrenaline, dopamine, glutamate, and NMDA.Thanks,
Your thoughts?
Posted by SLS on September 4, 2004, at 11:18:05
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by pseudonym on September 4, 2004, at 10:40:05
Hi Pseudonym.
> My interest is in Cymbalta, and I would like to know if you can actually distinguish between the effects of all four substances in the CNS (see below). On the surface, it would seem difficult to ascribe benefits/effects to one or the other.
> You mentioned that your regimen included Abilify, Lamictal, Namenda, now in addition to Cymbalta. With this combination, you are affecting many neurotransmitters/receptors, including serotonin, noradrenaline, dopamine, glutamate, and NMDA.Wow. I'm going to have to think about that one for awhile. I probably could only identify what is doing what by removing them one at a time. Because I have been on and off these things a few times, I could probably guess which one was removed, but I don't think I could verbalize now the things I would experience in advance.
Abilify gives me more motivation and reduces anxiety and adds some socialability.
Lamictal gives me more physical energy and interest in things and reduces depression somewhat. When the dosage isn't too high, it promotes better concentration.
Namenda is difficult for me to assess right now. It initially produced significant improvements in depression and cognition. Right now, it might not be doing anything at all, but I am leaving it on board in case it provides an augmentative effect.
When Cymbalta began to do something a few days ago, it was a broad-spectrum antidepressant effect that affected most all symptoms.
- Scott
Posted by michael on September 4, 2004, at 13:54:25
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 4, 2004, at 8:05:21
> 9/4/2004
>
> Day 16 (6 days at 30mg; 10 days at 60mg)
>
> 60mg (30mg b.i.d.)
>
> I can't say that I feel any improvement, but I don't feel worse either. That's positive. On Wednesday, I definitely felt an improvement in depression that is not part of the normal course of my illness. I attribute it to Cymbalta. Unfortunately, most of that has disappeared. If there is anything positive going on, it is difficult to discern, but I believe I still have reason to be optimistic.
>
> Regarding side effects, there is still some mild sleepiness, but it is gradually disappearing. I have noticed a bit of hesitency in urination and perhaps some restricted flow.
>
> Cymbalta still feels very clean. I can't say that it is similar to any of the other drugs mentioned along this thread because I hardly know that I am taking it. Most of the others made themselves known by producing some kind of perceptible cognitive effect. This is producing none. Maybe I'm not taking enough.
>
>
> - ScottHey Scott -
Just a quick thought to muddy the waters for you...
The transient improvement that you mentioned on Wednesday - might there be a "window" / range such that going to a higher dose might nullify the positive effects?
I know - impossible to know now... and I'd keep increasing the does myself, just to see if that makes it work better. But just thought I'd mention it, in case you may want to explore that later, should escalating the dose not help as much as you're hoping for. Just an idea... And thanks for your "off-PB" feedback recently.
As always, wishing you the best of luck~!
(also as always, feel free to, but no reply necessary)michael
Posted by awatts on September 4, 2004, at 14:36:47
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by michael on September 4, 2004, at 13:54:25
I'm watching your Cymbalta progress with great interest - please keep posting, everybody. I will be starting Cymbalta soon - as soon as I get all of the Effexor out of my system.
Effexor XR was working for me (150mg), but I decided that I was no longer willing to be shut down sexually. My hope is that Cymbalta will work on the depression/motivation as well as Effexor did WITHOUT making orgasm impossible.
If anyone notices adverse sexual effects from Cymbalta, please post!
Thanks.
Posted by theo on September 5, 2004, at 17:27:37
In reply to Re: Cymbalta (duloxetine) - report, posted by awatts on September 4, 2004, at 14:36:47
I hear a lot of people saying Effexor helped them with motivation and for me, it made me more emotionally flat and numb to where it didn't give a darn about the 2 feet of paper work stacking up on my desk.
Is norepinephrine really the "key" to motivation?
Posted by 4WD on September 5, 2004, at 18:22:57
In reply to Re: Cymbalta (duloxetine) - report, posted by theo on September 5, 2004, at 17:27:37
> I hear a lot of people saying Effexor helped them with motivation and for me, it made me more emotionally flat and numb to where it didn't give a darn about the 2 feet of paper work stacking up on my desk.
>
> Is norepinephrine really the "key" to motivation?
>Effexor made me emotionally flat as well. No motivation, lots of apathy. No joy in anything. I don't know if the Effexor actually *caused* all that but it sure didn't take it away.
Everyone seems to agree, however, that Effexor doesn't have a norepinephrine effect at low doses. I was only taking 37.5 mg/day because of side effects so it would only have been affecting serotonin. Part of what I don't understand about this, though, is that I didn't get the SSRI side effects with Effexor that I did with Zoloft, Prozac, Celexa or Lexapro so it must have been doing *something* besides serotonin reuptake inhibition.
Anyway, I'm now on Cymbalta which I'm hoping to be able to take therapeutic dosage and then we'll see if norepinephrine has a motivational, anti-anhedonia effect.What's your dosage of Effexor? Is it a low one? I keep thinking the thing to do is add some dopamine stimulation.
Marsha
Posted by theo on September 5, 2004, at 19:21:24
In reply to Re: Cymbalta (duloxetine) - report » theo, posted by 4WD on September 5, 2004, at 18:22:57
I'm currently not on Effexor XR, haven't been in a couple of years.
I'm currently only taking Lamictal and was going to add Cymbalta, but a couple of doctors have cooled my jets a little about "wanting to try something new" so I think I will wait a few months to hear more personnal experiences versus what Lilly has pumped into the media, which I hope turns out to be positive and true.
I just remember being on Paxil one time feeling really good and Lexapro came out. Being the "newest and greatest" I was sucked in and switched, worst mistake I ever made.
What was worse was when I went back to the Paxil, it didn't work as good and I had side effects that I didn't have before.
I haven't been on any SSRI, SSNRI in a few months and have heard Prozac goes well with Lamictal. I think I'm going to try it and if it isn't doing the job in a few months and I've heard a positive response from personal friends taking Cymbalta, I might go for it.
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Dr. Bob is Robert Hsiung, MD,
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