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Dr. Bob is Robert Hsiung, MD,
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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
Posted by Lest on September 6, 2004, at 9:10:29
In reply to Re: Cymbalta (duloxetine) - report » 4WD, posted by theo on September 5, 2004, at 19:21:24
what side effects? or positives have you experienced, i might start it today, i have the prescription i just havent gotten it yet. i made my dr let me try cymbalta first but i had probs breathing on it, so now on to this
Posted by Lest on September 6, 2004, at 9:12:20
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.
how has lamictal helped you?
Posted by Denise1904 on September 6, 2004, at 10:00:00
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 6, 2004, at 8:50:42
Scott,
You're so selfless, surely, doesn't this indicate that Cymbalta is just another same as (me too) drug? I doubt that it works any more effectively really than Effexor and bringing new drugs out like this just wastes peoples time trying them.
Sorry to appear negative but it seems such a shame to get peoples hopes up yet again only to have them dashed.
Denise
Posted by rayray on September 6, 2004, at 10:03:50
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 6, 2004, at 8:50:42
Hi Scott,
I'm so sorry to hear that Cymbalta is not working out for you -- or at least not yet. How long a trial are you going to give it?For the last several weeks I've been scanning this board for your reports daily. You are so thoughtful and kind to do this and I (like many of your fans) appreciate it.
Hang in,
Ray
Posted by iris2 on September 6, 2004, at 10:50:58
In reply to Re: Cymbalta (duloxetine) - report » KaraS, posted by SLS on September 6, 2004, at 7:28:31
> Thanks Kara.
> 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.
>
>
> - ScottScott,
I have seen the large amount of effort you put towards helping and answering people on this board. Your tone is always positive and informative. You are always kind, caring and never step on anyone’s toes or are hurtful.
You have given me personally a lot of support.
I hope it is true that what comes around goes around. You should be receiving great kindness and support. I wish all this and more for you.
Hope the Cymbalta turns around for you. Perhaps you can ride on the wave of support coming your way for the time being.
Take care for we cherish and need you,
irene
Posted by iris2 on September 6, 2004, at 12:00:36
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by iris2 on September 6, 2004, at 10:50:58
Scott,
I forgot to add. I did not know before that the "grid" of medications I copied and gave to my pdoc was all your work. I recently saw a link to your web page. Thank you for that. He was actually jealous of it and asked me where I got the information. Also you’re a good-looking guy.
Lots going for you.
You talked about several different drugs you were interested in. I cannot remember them all. I know the one I am trying Milnacipran was one among many. So you have a lot to look forward to even if the Cymbalta is not your answer.
Let me (us) know what steps you plan on taking next. I know this is premature. It is helpful to me to have your experience and knowledge.You once provided a guide for me to different supplements. I do not remember them all. I have some of them. What do you think are the most important ones to take? What tests do you think are the most important? I am going to find a doctor to test cortisal. I have a book that has other suggested tests for people taking anti depressants. I have to read it again since I do not remember them. My doctor read it and refused to do any until I provided much research to back them up. It is too much for me to concentrate and cognitively do.
Grateful for your existence,
irene
Posted by 4WD on September 6, 2004, at 12:14:43
In reply to Re: Cymbalta (duloxetine) - report » iris2, posted by iris2 on September 6, 2004, at 12:00:36
Can you please supply a link to that web page?
Marsha
Posted by iris2 on September 6, 2004, at 13:01:54
In reply to Re: Cymbalta (duloxetine) - report, posted by 4WD on September 6, 2004, at 12:14:43
> Can you please supply a link to that web page?
>
> MarshaMarsha,
Here is the link to Scotts web page. There is a link to the drug "grid" orchart there.
http://home.att.net/~sl.schofield/irene
Posted by pseudonym on September 6, 2004, at 13:20:36
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 6, 2004, at 8:50:42
As for your current situation, I believe Abilify + Cymbalta would not be a bad route to pursue.
It seems clear from your approach that you are targeting DA and NA neurotransmitters. Serotonergic drugs don't seem to help you much, correct? Given that you were most helped by Parnate and desipramine, it would seem likely that the selegiline patch, when released, by Watson in combination with Mylan pharmaceuticals, would be the best treatment on the surface. Why? It mediates the release of both NA and DA.
I can't determine what Lamictal and Namenda are doing for you or what lead you to take them. I recollect your explanation for Lamictal had to with "interest" and "physical energy". I would think that Abilify would be enough to do that. Your thoughts?
My two cents
Posted by theo on September 6, 2004, at 13:55:23
In reply to Re: Cymbalta (duloxetine) - report » 4WD, posted by SLS on September 5, 2004, at 20:35:57
I'm curious, my mid afternnons are my worst times also. From your past experiences, which AD's helped you better, SSRI's, Tricyclics?
Posted by theo on September 6, 2004, at 13:59:44
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 5, 2004, at 20:49:17
> > 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.
>
>
> - ScottThat same thing happened to me with Effexor XR, that feel good teaser that unfortunately didn't continue.
Posted by mattw84 on September 6, 2004, at 14:08:56
In reply to Re: Cymbalta (duloxetine) - report for SLS JB » jrbecker, posted by mxrider on August 30, 2004, at 17:22:32
I know everyone here seems to think that wellbutrin is useless in SP.... Just thought I would share this.***********************************************************************
Bupropion-SR in treatment of social phobia.
by
Department of Psychiatry and Behavioral Sciences
Medical University of South Carolina, Charleston 29425, USA.
Emmanuel NP, Brawman-Mintzer O, Morton WA, Book SW, Johnson MR, Lorberbaum JP, Ballenger JC, Lydiard RB.
Depress Anxiety. 2000;12(2):111-3.ABSTRACT
A 12-week, open label flexible dosing study was conducted to evaluate the efficacy of bupropion-SR in the treatment of generalized social phobia. The primary outcome measures include the Clinical Global Impression of Improvement (CGI-I) and the Brief Social Phobia Rating Scale (BSPS). A total of 18 subjects were enrolled. Five of the ten subjects who completed all 12 weeks were considered as responders. Response to treatment was defined as a CGI-I score of 1 or 2, ("much improved" or "very much improved," respectively) and a > 50% decrease in BSPS score. The final doses for the completers ranged between 200 and 400 mg/day (mean 366 +/- 68 mg/day). The medication was generally well tolerated. Findings from this open-label trial suggest that bupropion-SR may be useful in treating generalized social phobia.
***********************************************************************
Posted by theo on September 6, 2004, at 14:09:05
In reply to theo, posted by Lest on September 6, 2004, at 9:12:20
It's hard to pin down the dosage, at 100mg I don't really feel much effectiveness and not many side effects. When I go above to 150mg, I feel a little more at ease in group settings but also am not sharp and on my feet like normal which means I'm experiencing side effects such as word retrieval and short term memory. Not horrible but just enough to bother me.
I recently went back down to 100mg Lamictal and am going to add 10mg of Prozac and see what happens.
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