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Dr. Bob is Robert Hsiung, MD,
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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.
Posted by 4WD on September 5, 2004, at 20:12:47
In reply to Re: Cymbalta (duloxetine) - report » 4WD, posted by theo on September 5, 2004, at 19:21:24
> 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.
I didn't think Lamictal alone was effective for depression. I was on Prozac for nine years and did quite well emotionally for the first five or six years. If you haven't tried it before, it might work for you.
Posted by 4WD on September 5, 2004, at 20:26:54
In reply to Cymbalta (duloxetine) - report, posted by SLS on August 21, 2004, at 8:13:25
Scott,
Is your depression characterized by melancholia or more by apathy/anhedonia?
Do you find that you feel worse during the day and better at night?
Marsha
Posted by SLS on September 5, 2004, at 20:35:57
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by 4WD on September 5, 2004, at 20:26:54
Hi Marsha
> Is your depression characterized by melancholia or more by apathy/anhedonia?
Anergia, anhedonia, loss of interest, decreased libido, increased eating, increased sleeping, poor memory and concentration, heavy limbs, psychomotor retardation, social anxiety, derealization.
> Do you find that you feel worse during the day and better at night?
Morning is my best time. My worst time is between 1:00pm - 3:00pm.
I don't think Cymbalta is going to work out for me. All of the positive signs that appeared last week have now disappeared. This is a very familiar pattern, and I would like not to place too much more hope in that it will eventually work. Still, I will go the full tour with it.
- Scott
Posted by Paul_d_234 on September 5, 2004, at 20:38:52
In reply to Re: Cymbalta (duloxetine) - report » 4WD, posted by SLS on September 5, 2004, at 20:35:57
Scott,
What makes you think it will not work? Did you experience any side affects? Is your mood getting depressed? How do you know it is not working?
Posted by SLS on September 5, 2004, at 20:49:17
In reply to Re: Cymbalta (duloxetine) - report, posted by Paul_d_234 on September 5, 2004, at 20:38:52
> Scott,
>
> What makes you think it will not work? Did you experience any side affects? Is your mood getting depressed? How do you know it is not working?On Wednesday, I experienced a brightening of mood, an increase in interest and motivation, and an improvement in memory and concentration beyond anything I experience during the normal course of my illness. By Saturday this had pretty much disappeared, and by this afternoon, my condition deteriorated substantially. My experiences in the past with this pattern of events is that no further antidepressant response will occur, regardless of how high the dosage goes or how long I stick with it. This phenomenon is idiosyncratic to me, and not to be generalized to the population in general.
I am still trying to be positive, but there is no longer optimism. This has happened too many times already.
- Scott
Posted by 4WD on September 5, 2004, at 21:05:32
In reply to Re: Cymbalta (duloxetine) - report » 4WD, posted by SLS on September 5, 2004, at 20:35:57
> Anergia, anhedonia, loss of interest, decreased libido, increased eating, increased sleeping, poor memory and concentration, heavy limbs, psychomotor retardation, social anxiety, derealization.I guess that's why I feel such an empathy with you. All of the above except poor memory, social anxiety and derealization but add tendency to abuse substances and insomnia. Perhaps it's the same with you as for me- your meds keep you out of the deep black clinical depression but never bring you up to normal.
> > Do you find that you feel worse during the day and better at night?
>
> Morning is my best time. My worst time is between 1:00pm - 3:00pm.Rats. I was hoping you'd say you felt better at night. I approach normality sometimes between 9 and midnight. Thinking it might be the cortisol thing - which could then be treated. It might be, though, for you. Aren't cortisol levels at their peak in the morning and then drop to their lowest levels around 3-4 pm?
> I don't think Cymbalta is going to work out for me. All of the positive signs that appeared last week have now disappeared. This is a very familiar pattern, and I would like not to place too much more hope in that it will eventually work. Still, I will go the full tour with it.
>
I was beginning to surmise as much. The daily reports kind of stopped. I am so very sorry. My own hopes are so high and I so hate to see yours dashed. I know you tried to guard against that but I bet you weren't able to. Do give it the whole try, though. Did the MAOIs poop out on you? You mentioned before success with those.I won't even try to make suggestions. It sounds as though you've been around the a/d block a few times. I just want you to know that I think about you and your struggle a lot. I also want you to know that I have been impressed with your intelligence and with the level of sensitivity you show in your posts to others.
I haven't tried nearly as many things as you but I know so well the feeling of wondering if you are going to have to live the rest of your life depressed and if there will ever be a med that will work.
You are in my prayers.
Marsha
Posted by 4WD on September 5, 2004, at 21:10:40
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 5, 2004, at 20:49:17
> On Wednesday, I experienced a brightening of mood, an increase in interest and motivation, and an improvement in memory and concentration beyond anything I experience during the normal course of my illness. By Saturday this had pretty much disappeared, and by this afternoon, my condition deteriorated substantially. My experiences in the past with this pattern of events is that no further antidepressant response will occur, regardless of how high the dosage goes or how long I stick with it. This phenomenon is idiosyncratic to me, and not to be generalized to the population in general.
>
> I am still trying to be positive, but there is no longer optimism. This has happened too many times already.
>
>
> - Scott
It almost seems like some sort of auto-immune response. It starts to work, your body figures out what's happening and promptly inactivates it. Have you ever been tested for CFS, fibromyalgia, lupus, etc.?How old are you?
Marsha
Posted by alesta on September 5, 2004, at 21:20:42
In reply to Re: Cymbalta (duloxetine) - report » 4WD, posted by SLS on September 5, 2004, at 20:35:57
hi, scott,:)i'm really sorry to hear that the cymbalta isn't working yet...i'll keep my fingers crossed for ya, hon. :)
i was wondering what kind of results you had when you took an maoi (nardil or parnate). did they work for you?
thanks, and keep your chin up! :)
amy
Posted by hope4best on September 5, 2004, at 22:12:34
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by 4WD on September 5, 2004, at 21:05:32
Marsha, I would just like to say thank you for expressing so eloquently the care and gratitude that so many of us feel for Scott for sharing his Cymbalta experience. You are obviously a very caring and empathetic soul, and your words echo the very thoughts I have when I read the posts on this board. My prayers include you both.
Posted by KaraS on September 6, 2004, at 3:27:08
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 5, 2004, at 20:49:17
Scott,
I just received an interesting post on the Alternative Board and I thought of you. This guy, "raybakes", had some testing done and discovered a couple of things about himself:"I had a liver genetic test done by great smokies labs and I have a null gene for one of my glutathione enzymes."
and
"Also had great smokies immune genetic profile done, and I have a polymorphisms in my interleukin 1 receptor antagonist gene! It means that I'm prone to chronic inflammation from unopposed expression of interleukin 1 - seems people with autoimmune disease frequently have this polymorphism. High levels of interleukin 1 can trigger free radical production and all the mitochondrial problems mentioned before."
Raybakes because of testing and his own research was able to turn himself from a nonresponder with regard to taking DLPA and tyrosine, into a responder. I figured that something along those lines might also work for someone who is a nonresponder to medications.
Maybe you've already had the kind of testing done that he refers to in his post, but if not, it might be something to add to your toolbox.
Here's the link if you're interested in reading more. There's probably a lot there about supplements that might not interest you (esp. in the beginning of the post) but overall I think you might get something out of it.
http://www.dr-bob.org/babble/alter/20040901/msgs/386715.html
Kara
Posted by SLS on September 6, 2004, at 7:28:31
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by KaraS on September 6, 2004, at 3:27:08
Thanks Kara.
> Maybe you've already had the kind of testing done that he refers to in his post, but if not, it might be something to add to your toolbox.
I can't believe you went out of your way to do this for me. I'm not used to the kind of support that I have been receiving here over the last few weeks. I really, really, really do appreciate it.
Thanks.
- Scott
Posted by SLS on September 6, 2004, at 8:50:42
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 4, 2004, at 8:05:21
9/6/2004
Day 18 (6 days at 30mg; 12 days at 60mg)
60mg (30mg b.i.d.)
My condition is deteriorating. I have lost all the positive antidepressant effects that Cymbalta provided me last week.
I am experiencing increased anergia, loss of interest and motivation, flat affect, impaired memory and concentration, and mental fatigue. These things are normal for my disease state, and are not the result of a Cymbalta-induced worsening.
No side effects.
For what it's worth, because this pattern of response and relapse is the same for me with Cymbalta versus other antidepressants that have proven effective for other people, I am optimistic that Cymbalta will be a valuable drug.
- Scott
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