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Dr. Bob is Robert Hsiung, MD,
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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.
Posted by theo on September 6, 2004, at 14:11:30
In reply to Re: Cymbalta (duloxetine) - report » iris2, posted by iris2 on September 6, 2004, at 12:00:36
What grid, what link?
Posted by iris2 on September 6, 2004, at 14:42:01
In reply to Re: Cymbalta (duloxetine) - report » iris2, posted by theo on September 6, 2004, at 14:11:30
> What grid, what link?
Sorry. I was speaking of Scott's home page
http://home.att.net/~sl.schofield/
with a link to a medication "grid" as I call it:
http://sl.schofield3.home.att.net/medicine/psychiatric_drugs_chart.htmlirene
Posted by tedar on September 6, 2004, at 15:06:25
In reply to Re: Cymbalta (duloxetine) - report, posted by theo on September 6, 2004, at 13:59:44
There just isn't any good data to suggest that Cymbalta is the answer for the upcoming years. Lilly has been trying to reinvent the next Prozac for years. We all need to keep our hopes up, but isn't this just a little cleaned up version of a tricyclic? Its discontinuation rate(do to Tolerability) in the PI was significantly higher than with the SSRIs.
Posted by mxrider on September 6, 2004, at 15:18:59
In reply to Note about wellbutrin and Soc Anx » mxrider, posted by mattw84 on September 6, 2004, at 14:08:56
>
> 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.
>
>
> ***********************************************************************Thanks for that post. That is interesting for sure...I wouldn't have thought that was the case.
I personally have postponed my Wellbutrin trial as I am having a brain scan/consultation done at the Amen clinic next week. I know this is a controversial procedure, however, after 20+ years of on and off misery, I've decided to do whatever it takes to get myself "better". I had a head injury as a young teen that occurred around the time every thing went to hell. It could be coincidental, who knows? But, I would sure like to know.Thanks,
Chris
Posted by jessie77 on September 6, 2004, at 15:59:55
In reply to Re: Note about wellbutrin and Soc Anx, posted by mxrider on September 6, 2004, at 15:18:59
ive been on cymbalta a little over a week. not to be gross, but I am seriously constipated. has this happened to anyone else?
Posted by mattw84 on September 6, 2004, at 16:01:35
In reply to Re: Note about wellbutrin and Soc Anx, posted by mxrider on September 6, 2004, at 15:18:59
I wish you the best! I have debated getting a SPECT scan done, as most of Doc Amen's patients seem to have a great outcome. I live only like 30 minutes from the clinic, only hold up is the $4000 price tag! If you end up getting the scan done be sure and keep us all posted! Good Luck!
Matt
Posted by 4WD on September 6, 2004, at 17:06:55
In reply to cymbalta side effects, posted by jessie77 on September 6, 2004, at 15:59:55
> ive been on cymbalta a little over a week. not to be gross, but I am seriously constipated. has this happened to anyone else?
I've been on it for 4 days now. No problems. It was a slight problem in the first couple of weeks on Effexor, though.
Marsha
Posted by KaraS on September 6, 2004, at 18:01:42
In reply to Re: Cymbalta (duloxetine) - report » KaraS, posted by SLS on September 6, 2004, at 7:28:31
> 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
You're welcome.BTW, I just checked out your web site and I'm still recovering from the shock. You're the last person in the world I would have thought would be into body building. First off, because you seem so cerebral but mostly because you've commented more than once on how much you hate exercise.
I couldn't help but wonder if you were depressed when you created the site. You certainly couldn't tell if you were. And, if you were, I can only imagine what you'd be capable of if you weren't depressed!
Kara
Posted by boomarang on September 6, 2004, at 18:04:19
In reply to Re: Note about wellbutrin and Soc Anx, posted by mxrider on September 6, 2004, at 15:18:59
i am so curious to hear how the amen clinic works out for you. try to keep us posted if possible.
Posted by mxrider on September 6, 2004, at 18:19:58
In reply to Re: Note about wellbutrin and Soc Anx » mxrider, posted by boomarang on September 6, 2004, at 18:04:19
> i am so curious to hear how the amen clinic works out for you. try to keep us posted if possible.
I will certainly post my experience with the Amen clinic in a couple of weeks. Hopefully I will learn something there. I will start a new thread so as not to intrude on the Cymbalta discussion.
Posted by Iansf on September 7, 2004, at 0:43:35
In reply to Note about wellbutrin and Soc Anx » mxrider, posted by mattw84 on September 6, 2004, at 14:08:56
I've been taking Wellbutrin, 450mg/d, for a long time. I find it moderately helpful for depression but absolutely useless in regard to social phobia. I have a friend who takes it for generalized anxiety disorder, with fair success, but I've never encountered anyone with social phobia who was helped by it. My one doctor even prescribed it for me at 600mg/d - still no help for social phobia. I wish.
>
> 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 SLS on September 7, 2004, at 8:10:56
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by KaraS on September 6, 2004, at 18:01:42
Hi Kara.
> BTW, I just checked out your web site and I'm still recovering from the shock. You're the last person in the world I would have thought would be into body building. First off, because you seem so cerebral but mostly because you've commented more than once on how much you hate exercise.
I don't hate exercise. I am just too depleted of energy to do it. I actually enjoyed my workouts. I keep telling myself that I would profit from getting back into the gym, but I have a tough time convincing myself to walk a block to go to the mailbox. Unlike the many accounts of the benefits of exercise on depression, I received none. Pooh.
The website I put together uses only the simplest of HTML coding. It looks more impressive than it really is. And yes, I was depressed when I did it. I was motivated for some reason. I think it was because it was novel and provided a distraction. I wish something else would capture enough of my interest to draw me through the depression to invest time in. Right now, I have no motivation at all. I guess I'm burned-out from pushing so hard just to survive over the last few years.
- Scott
Posted by theo on September 7, 2004, at 8:13:52
In reply to Re: Cymbalta (duloxetine) - report » KaraS, posted by SLS on September 7, 2004, at 8:10:56
Did you mention you might be discontinuing Cymbalta?
Posted by SLS on September 7, 2004, at 8:32:03
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by pseudonym on September 6, 2004, at 13:20:36
Hi Pseudonym.
> As for your current situation, I believe Abilify + Cymbalta would not be a bad route to pursue.
I have been taking Abilify 10mg for about a year now. It helps a little, I guess. When I first began taking it, I noticed an improvement in motivation and sociability. I'm not sure it is doing that much anymore, but I continue to take it to help keep me from entering severely suicidal states. I didn't find any additional benefit from going to 20mg.
> It seems clear from your approach that you are targeting DA and NA neurotransmitters.
That's what I have had success with in the past, but I wouldn't discount the importance that modulating serotonergic neurotransmission might have. I do wish that nomifensine and amineptine were still around.
> Serotonergic drugs don't seem to help you much, correct?
SSRIs have not been much help.
> 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.
Hmm. I guess I should move it closer to the top of my list. I didn't have too much interest in it initially because I failed a course of oral selegiline. However, I only went up to 30mg. Thanks.
> 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?
I have tried to discontinue or lower the dosage of Lamictal several times over the last year without success. It does help enough to continue with it, but it only seems to help when I am taking TCAs at the same time. Since beginning Namenda, I have been able to reduce my dosage of Lamictal to 150mg; low enough so that it doesn't impair my memory and cognition as much as it did at 300mg. Both drugs inhibit glutamatergic neurotransmission: Lamictal through glutamate release inhibition and Namenda through glutamate receptor (NMDA subtype) blockade. Because these anti-glutamatergic drugs have had some positive effect, I have my eye on riluzole (Rilutek), another release inhibitor now being used to treat amyotrophic lateral sclerosis (ALS), sometimes referred to as Lou Gehrig's Disease. Riluzole was recently reported by the NIMH to demonstrate antidepressant effects in a clinical trial to treat bipolar depression.
> My two cents
A worthwhile investment to be sure!
Thanks again. I'll definitely place the patch higher on my list.
- Scott
Posted by SLS on September 7, 2004, at 8:38:11
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by theo on September 7, 2004, at 8:13:52
> Did you mention you might be discontinuing Cymbalta?
No, Theo. Despite my disappointment, I will continue to take Cymbalta and give it a full trial. It makes sense to continue with it for another 4-6 weeks. I'll spend 1-2 more weeks at 60mg, and then petition my doctor to go up to 80-120mg. At the moment, I still have hopes that it will work. (Of course, this outlook is very changeable).
- Scott
Posted by SLS on September 7, 2004, at 8:50:27
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 6, 2004, at 8:50:42
9/7/2004
Day 19
6 days at 30mg
12 days at 60mg60mg (30mg b.i.d.)
I have recovered from the plummet into a more severe depression that I experienced two days ago. One of my doctors at the NIMH described such an event as a "reset" of the brain that he believed occurred from time to time during the period of recovery. I hope that's what it was. I am still not experiencing the unequivicol antidepressant response I did at this time last week, but I can't help but to retain hope. Right now, there are still a few signs that it might be doing something positive.
No side effects. Although my sex-drive is still very low from depression, it has not been lowered further by Cymbalta in the same way it was from Zoloft. I have no problems achieving orgasm.
I still think Cymbalta will be a great drug for many people. I would not discourage anyone from trying it at this point.
- Scott
Posted by Paul_d_234 on September 7, 2004, at 8:55:53
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 7, 2004, at 8:50:27
Scott,
Any thoughts on its effect on weight gain / weight loss.
Zoloft works great for me for depression/anxiety but the weight gain is very high for me.
Posted by SLS on September 7, 2004, at 9:07:58
In reply to Re: Cymbalta (duloxetine) - report, posted by Paul_d_234 on September 7, 2004, at 8:55:53
> Scott,
>
> Any thoughts on its effect on weight gain / weight loss.
>
> Zoloft works great for me for depression/anxiety but the weight gain is very high for me.Hi Paul.
I have not noticed any tendency towards weight gain over these last few weeks. I am not that prone to it with SSRIs, so I don't think I am a reliable subject to indicate whether or not Cymbalta will demonstrate this as a side effect.
- Scott
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