![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 130 to 154 of 335. Go back in thread:
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
Posted by iris2 on September 7, 2004, at 9:13:35
In reply to Re: Cymbalta (duloxetine) - report » KaraS, posted by SLS on September 7, 2004, at 8:10:56
Scott,
You are just interesting and I admire you so much. If you don't mind my asking are you employed currently or working?
irene
Posted by iris2 on September 7, 2004, at 9:17:51
In reply to Re: Cymbalta (duloxetine) - report » theo, posted by SLS on September 7, 2004, at 8:38:11
I am going to start this as soon as I recieve it. I have not seen much information about people taking it on the board. I was going to post how I am doing on it but I do not want to make the assumption that anyone is interested if no one is. I would appreciate a post back if there is an interest.
My perceptions are not so keen so if I do post it will be a more general nature.
irene
Posted by SLS on September 7, 2004, at 9:27:54
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by iris2 on September 7, 2004, at 9:13:35
Hi Irene.
I am so very glad you came back to post after your block.
> You are just interesting and I admire you so much.
:-) :-) :-) :-) :-) :-) :-) :-) :-)
The feeling is mutual.
> If you don't mind my asking are you employed currently or working?No.
I haven't worked since April 15, 1990 (damn). I really do hate having to be part of the public burden. Maybe that will change soon.
- Scott
Posted by SLS on September 7, 2004, at 9:34:20
In reply to Milnacipran » SLS, posted by iris2 on September 7, 2004, at 9:17:51
> I am going to start this as soon as I recieve it. I have not seen much information about people taking it on the board. I was going to post how I am doing on it but I do not want to make the assumption that anyone is interested if no one is. I would appreciate a post back if there is an interest.
>
> My perceptions are not so keen so if I do post it will be a more general nature.
>
> irene
Of course I will be interested in following your progress, if not from a continued selfish pursuit of effective treatments for myself, then certainly from a personal interest in your finding an effective treatment of your own.Posting a journal here is always appreciated and represents invaluable information to help others make treatment decisions and to further the understanding of these illnesses in general.
Why have you chosen to proceed with milnacipran now that Cymbalta is available?
- Scott
Posted by Racer on September 7, 2004, at 12:41:32
In reply to Re: Milnacipran » iris2, posted by SLS on September 7, 2004, at 9:34:20
I can't find any info on it, might it be an alternative for some of me who don't seem to be making friends with Cymbalta?
Thanks.
Posted by snapper on September 7, 2004, at 13:09:04
In reply to Re: what is Milnacipran?, posted by Racer on September 7, 2004, at 12:41:32
> I can't find any info on it, might it be an alternative for some of me who don't seem to be making friends with Cymbalta?
>
> Thanks.Hi Racer, Milnacipran is also a "dual re-uptake inhibitor", I believe it is a French AD. I believe that it is clinical trials here in the US to help treat fibromyalgia. It has been in europe for quite some time but I don't know much about its efficacy and also don't know much about the possibility of it being approved here anytime soon.Most likely not any time soon, now that Cymbalta has been released. If you want to read about it, just type in the name "Ixel" in your search engine and you should be able to find plenty of info on it! Good Luck
Snapper
Posted by SLS on September 7, 2004, at 13:09:05
In reply to Re: what is Milnacipran?, posted by Racer on September 7, 2004, at 12:41:32
> I can't find any info on it, might it be an alternative for some of me who don't seem to be making friends with Cymbalta?
>
> Thanks.
You'll make friends, don't worry. Some relationships take a while to build. How much Cymbalta are you taking right now, and what is it that you don't like about it?Milnacipran is a French SNRI drug that has been around for quite a few years. I have never spoken to anyone who has worked with it, so I don't have an impression as to its efficacy or side effect profile.
- Scott
Posted by 4WD on September 7, 2004, at 14:14:46
In reply to Milnacipran » SLS, posted by iris2 on September 7, 2004, at 9:17:51
> I am going to start this as soon as I recieve it. I have not seen much information about people taking it on the board. I was going to post how I am doing on it but I do not want to make the assumption that anyone is interested if no one is. I would appreciate a post back if there is an interest.
>
> My perceptions are not so keen so if I do post it will be a more general nature.
>
> irene
Irene,I would be very interested to hear how your trial of milnaciprin goes. I hope you do post a journal - it sounds like a good option.
Marsha
Posted by nmk on September 7, 2004, at 14:19:55
In reply to Re: Milnacipran » iris2, posted by 4WD on September 7, 2004, at 14:14:46
test
Posted by nmk on September 7, 2004, at 14:27:17
In reply to Re: Milnacipran, posted by nmk on September 7, 2004, at 14:19:55
Sorry about the earlier test message. My registration must have expired and I couldn't post for awhile.
Anyway, I wanted to let you know that I think I am the first person on this board to discontinue Cymbalta. It had only been a week at 30 mg but I couldn't tolerate the side effects anymore. There was an evident increase in anxiety, dizziness, and I had difficulty sleeping. When I was on Effexor a few years back, I experienced the exact s/e's, which did not go away after a two month trial. So, my pdoc and I thought it would be best to discontinue since side effects typically don't go away with me. Also, I didn't want to suffer through two months of side effects and then be confronted with a potential horrible withdrawal.
I know many of you are doing well on Cymbalta and I wish you continued success. It just wasn't meant to be for me and Cymbalta.
Nicole:(
Posted by SLS on September 7, 2004, at 14:39:06
In reply to Re: Milnacipran, posted by nmk on September 7, 2004, at 14:27:17
Hi Nicole.
> I know many of you are doing well on Cymbalta and I wish you continued success. It just wasn't meant to be for me and Cymbalta.What options are you considering?
- Scott
Posted by nmk on September 7, 2004, at 15:38:32
In reply to Re: Milnacipran, posted by SLS on September 7, 2004, at 14:39:06
>>
> What options are you considering?
>
>
> - ScottHi Scott,
My doc has three options he wants me to consider: 1) a TCA (clomiprimine to be exact) 2) Parnate and 3)Lupron injections to shut down my ovaries and add back estrogen.
#3 is due to the fact that I feel fine during the first half of my cycle but worsen premenstrually.
I don't know what to do. I have tried practically every ssri, snri, and four mood stabilizers. I get anxious, agitated, irritable and depressed for half of the month and am convinced that even though my hormones drive this, there is a bipolar component to this whole mess. I have tried Lamictal, Trileptal, Zyprexa, and Depakote to no avail.
I really don't know what to do next.
Do you think I should play it safe and try a tca or move on to something like Parnate. Lupron scares the life out of me.Thanks,
Nicole
Posted by Racer on September 7, 2004, at 15:44:08
In reply to Re: what is Milnacipran?, posted by SLS on September 7, 2004, at 13:09:05
I'm at 60, since last Thursday. Today I'm jumping out of my skin again, but still can't seem to *do* anything much. That's still an improvement over the weekend, though: I spent most of it either asleep or just immobilized on the sofa. No real energy -- beyond the agitation -- no motivation, no ability to follow through, and for most of the weekend I just didn't feel as if living was worth it.
Again, this is still adjustment phase, which I know, but unless things start to show signs of turning around very soon -- like less restlessness and jitteriness, and less sedation and amotivation -- I'm not all that hopeful about it. The combination of being keyed up and feeling so paralysed is not a good one for me -- it tends to be the thing that leads to much increased suicidal impulses. (Which is going on right now, by the way.)
The good news is that I've got some support from a couple of someones here who keeps reminding me that I really have been through hell for an extended visit, so everything is still pretty distorted. One of them keeps reminding me that it might still turn around, and encouraging me to keep trying. So far, I have. More out of inertia, I think, but the end result is the same. I'm giving it a chance, and next week I see Dr NoName again and can discuss it with him. So far, I've been able to say, "it's only a week more, surely I can manage it that long?" Part of the problem is that I get such tunnel vision, you know? It seems as if this moment is all that's ever existed, so if it's horrible, then it's always going to be horrible. The most insidious part of the disease process, I guess.
Thanks for your support, Scott. Hope you had a good weekend -- without any bull sharks ;-)
Posted by iris2 on September 7, 2004, at 15:55:16
In reply to Re: Milnacipran » iris2, posted by SLS on September 7, 2004, at 9:34:20
Scott,
To be sure after waiting this interminable time fo the Cymalta approval I cannot for the life of me remember why I ended up deciding to try this one first. It makes no sense since a huge problem is interstitial cystitis and the Cymalta might help with that!irene
Posted by iris2 on September 7, 2004, at 16:03:23
In reply to Re: what is Milnacipran?, posted by Racer on September 7, 2004, at 12:41:32
I think so. You could google Ixel if you are not finding Milnacipran.
Here's some stuff off of one site:
It is possible that duloxetine (Cymbalta), due to be FDA-licensed in 2004, and milnacipran (Ixel), available in Europe, may be more effective than venlafaxine for a segment of the population that can benefit from dual serotonin-noradrenaline reuptake inhibition. Pain-ridden and melancholic depressives in particular may respond well to this class of drug. Once again, dopaminergic augmentation may be beneficial for the naturally lethargic. Unlike venlafaxine, duloxetine exerts its more balanced serotonin and noradrenaline reuptake inhibition throughout the dosage range. Duloxetine also weakly inhibits the reuptake of dopamine, and shows minimal affinity for the histamine and cholinergic muscarinic receptors. But it takes time to separate genuine therapeutic advance from drug company hype, typically not until the patent expires.
Milnacipran (Ixel) is a new antidepressant with essentially equal potency for inhibiting the reuptake of both serotonin and noradrenaline, with no affinity for any neurotransmitter receptor studied. A review of the studies comparing milnacipran, placebo and active comparator antidepressants provides clear-cut evidence of its efficacy in both severe and moderate depression in hospitalized and community settings. Meta-analyses of the original data of controlled trials involving 1032 patients, comparing milnacipran with imipramine or selective serotonin reuptake inhibitors (SSRIs), show that milnacipran provides antidepressant efficacy similar to that of imipramine and significantly superior to that of the SSRIs. An analysis of a database of over 3300 patients shows that both the general and cardiovascular tolerability of milnacipran are superior to those of the tricyclic antidepressants (TCAs) with fewer cholinergic side-effects. The tolerability of milnacipran was comparable to that of the SSRIs, with a higher incidence of dysuria with milnacipran, and a higher frequency of nausea and anxiety with the SSRIs. Milnacipran is a new therapeutic option in depression, which offers a clinical efficacy in the range of the TCAs combined with a tolerability equivalent to that of the SSRIs.
Milnacipran (Ixel) is a new antidepressant which has been developed for its selective inhibition of both serotonin and noradrenaline reuptake and its lack of affinity for neurotransmitter receptors. It inhibits virtually equipotently the reuptake of serotonin and noradrenaline both in vitro and in vivo, as demonstrated by the antagonism of centrally acting monoamine displacers. It has no effect on dopamine reuptake. In addition, milnacipran has been shown by intracerebral microdialysis to increase the extracellular levels of both serotonin and noradrenaline after acute administration. Milnacipran is devoid of interactions at any known neurotransmitter receptor or ion channel. In particular, and unlike tricyclic antidepressants, it does not act at noradrenergic, muscarinic or histaminergic receptors. Contrary to tricyclic antidepressants, chronic administration of milnacipran does not modify beta-adrenoceptor binding or second messenger function. Milnacipran is active on various animal models of depression such as the forced swimming test in the mouse, learned helplessness in the rat and the olfactory bulbectomized rat model. This pharmacological profile, associated with an excellent bioavailability in man, was predicted to be that required for a powerful and well-tolerated antidepressant. Subsequent clinical development has shown this prediction to be well founded.
Milnacipran (MIL) is a representative of a new class of antidepressants (SNRIs) which inhibit the reuptake of serotonin and noradrenaline, but, in contrast to tricyclics, show no affinity for neurotransmitters receptors. The present study was aimed at determining whether repeated MIL administration (given at doses of 10 or 30 mg/kg, twice daily for 14 days) induced the adaptive changes in the dopaminergic system similar to those reported by us earlier for tricyclic antidepressants. The obtained results showed that MIL administered repeatedly did not change the responsiveness of dopamine D1 receptors since it did not change the SKF 38393-induced grooming. Repeated MIL treatment increased the hyperlocomotion induced by D-amphetamine and 7-OH-DPAT, but did not affect the D-amphetamine and apomorphine stereotypies. The binding parameters (Bmax and Kd) to dopamine D1 and D2 receptors in the limbic forebrain were not affected by repeated MIL treatment when [3H]SCH 23390 and [3H]spiperone, respectively, were used as ligands. On the other hand, the increased density of dopamine D2 receptors (Bmax) was observed in the striatum after repeated treatment with MIL. MIL administered acutely or repeatedly did not change the binding of [3H]7-OH-DPAT to dopamine D3 receptors in the islands of Calleja and the shell region of the nucleus accumbens septi. The above results indicate that repeated MIL administration induces the adaptive changes in the dopaminergic system, especially it enhances the functional responsiveness of dopamine D2 and D3 receptors. However, the question whether this increased functional responsiveness is important for the clinical antidepressant efficacy, remains open.
OBJECTIVE: The principal objective was to compare the effects of milnacipran, an antidepressant characterized by a dual-action on serotonin and noradrenaline reuptake, with placebo on memory, attention and psychomotor performance in healthy volunteers. The secondary objective was to evaluate the effects of milnacipran on mood, anxiety and vigilance in these subjects. METHODS: In a double-blind crossover randomized trial, milnacipran (50 mg b.d.) or placebo was administered during two periods of 7 days separated by a washout period of 7 days. Memory tests (recall of words, images and coloured bars), tests to evaluate attention and vigilance (squares test, critical flicker fusion test and choice reaction time test) and visual analogue scales for affect and sleep were used. RESULTS: There were no significant differences between milnacipran and placebo groups with respect to the psychomotor functions tested. No differences were observed in the Norris scales for vigilance, anxiety or satisfaction or in the sleep questionnaire (sleep latency, sleep quality and waking). CONCLUSION: Milnacipran, administered at 100 mg per day for 7 days to healthy volunteers, had no effects on cognitive functions.
irene
Posted by SLS on September 7, 2004, at 16:03:26
In reply to Re: Milnacipran » SLS, posted by iris2 on September 7, 2004, at 15:55:16
> Scott,
> To be sure after waiting this interminable time fo the Cymalta approval I cannot for the life of me remember why I ended up deciding to try this one first. It makes no sense since a huge problem is interstitial cystitis and the Cymalta might help with that!
>
> irene
I'm glad you see it my way.:-)
I just wanted to provoke you into doing some thinking - just to be sure.
Good luck! Either way.
- Scott
Posted by SLS on September 7, 2004, at 16:53:35
In reply to Re: Milnacipran » SLS, posted by nmk on September 7, 2004, at 15:38:32
Hi Nicole.
> Lupron scares the life out of me.
It should. I once looked into it for a friend as a treatment for endometriosis. It has a reputation for doing some pretty scary things. I would have thought Yasmin to be the better choice for PMDD. I have never heard of your doctor's strategy. Maybe he has had success with it personally? I don't know. I hate to disuade people from trying something that their doctor feels strongly would work.
> I really don't know what to do next.
> Do you think I should play it safe and try a tca or move on to something like Parnate.If you have never tried a TCA, I guess that is the logical choice. I am not a big fan of clomipramine, even though it probably gets more people well than any of the others. It carries a pretty big burden of side effects, many of which are anticholinergic, and many of which are similar to the SSRIs. I would probably be more apt to try nortriptyline first. However, your doctor might have very good reasons for choosing clomipramine first, and I wouldn't want to second guess him.
MAOIs are always worth trying. I think Nardil makes more sense given your symptoms of anxiety and agitation. Why is your doctor leaning towards Parnate? I don't know why, but it seems to me that women do better on Nardil. That is ONLY a personal opinion based on some intuitive notions and observations. Make believe I never said it. Actually, there is some evidence that women respond less often to TCA than do men.
I think you should post a question on the Alternative board regarding the connection to your menstrual cycle. There are some things I'm sure Larry Hoover can suggest. I could list a few, but I feel more comfortable deferring to the people there who certainly know more than me.
Now that I have thoroughly confused you...
If you can afford the time to try a TCA before going with the MAOI, it would seem to make sense. You would avoid the diet restrictions and drug interactions or the MAOIs. It is pure guess work as to what you will eventually respond to, of course. You could at the same time begin to look into the alternative treatments geared towards the menstrual cycle.
Maybe:
1. TCA
2. concurrent alternative stuff (Evening Primrose Oil, vitamin B6, etc.)
3. MAOI
4. add hormone stuff
Wait for some other opinions. I need to think about this for awhile.
- Scott
Posted by SLS on September 7, 2004, at 17:01:15
In reply to Re: what is Milnacipran? » SLS, posted by Racer on September 7, 2004, at 15:44:08
Hi Racer.
> I'm at 60, since last Thursday. Today I'm jumping out of my skin again, but still can't seem to *do* anything much. That's still an improvement over the weekend, though: I spent most of it either asleep or just immobilized on the sofa. No real energy -- beyond the agitation -- no motivation, no ability to follow through, and for most of the weekend I just didn't feel as if living was worth it.
Ouch.
I'm glad you have decided to stick it out. I am leaning towards believing that these things are only temporary for you. I don't have the answers for you (right now), but I do have a willing ear. I hope that helps.
:-)
- Scott
Posted by T-rotten on September 7, 2004, at 17:20:16
In reply to Re: what is Milnacipran?, posted by SLS on September 7, 2004, at 13:09:05
> > I can't find any info on it, might it be an alternative for some of me who don't seem to be making friends with Cymbalta?
> >
> > Thanks.
>
>
> You'll make friends, don't worry. Some relationships take a while to build. How much Cymbalta are you taking right now, and what is it that you don't like about it?
>
> Milnacipran is a French SNRI drug that has been around for quite a few years. I have never spoken to anyone who has worked with it, so I don't have an impression as to its efficacy or side effect profile.
>
>
> - ScottWell here in Brasil milnacipran(ixel) is avaliable. Sometime ago when I went from paroxetine to Ixel I had good results. And all the others patients my pdoc did thid switch had improvments. So IMO milnacipran is better then any SSRIs.
Now, my situation is different but i'll lrt it to another thread.
Tanks.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.