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Dr. Bob is Robert Hsiung, MD,
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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.
Posted by SLS on September 7, 2004, at 17:37:19
In reply to Re: what is Milnacipran?, posted by T-rotten on September 7, 2004, at 17:20:16
> Well 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.
Hi T.Are you still taking Ixel? What side effects did you experience?
Thanks.
- Scott
Posted by nmk on September 7, 2004, at 17:38:50
In reply to Re: Milnacipran » nmk, posted by SLS on September 7, 2004, at 16:53:35
Hi Scott,
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.>>He did try me on Yasmin but the progestin in the pill sent me spiraling downward into a serious depression. The day after discontinuing the pill, I felt better. My pdoc is was an OB/GYN for the first 10 years of his career. His approach with the Lupron is to shut down my ovaries so that I do not have any hormonal flucuations throughout the month. It is the flucuations that cause my anxiety/depression at certain times of the month. Once we can get the hormonal flucuations out of the way, we can deal with whatever is left. He said that it has worked for many women but one must give it a three month trial period. He said the first month is the worst as far as side effects.
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.>>He doesn't have very good reasons because I asked him the same question. Can you please tell me how they compare? Particularly, which works best on anxiety, depression, and insomnia?
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.
>>He said the side effect profile is kinder with Parnate. Which works best on anxiety and depression with the fewest s/e's? You can say men are from mars and women are from venus. There is probably some truth to your theory since female reproductive hormones can effect the efficacy of a med so that the response is different in women.
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.>>Thanks Scott. I will.
> Now that I have thoroughly confused you...
Not at all. You have been a great help and I appreciate your response and your time and consideration. As you mentioned, trying a TCA would seem to be the next logical approach but part of me wants to say the #@*! with it....lets go for the MAOI. Then again, that scares me because a)the side effects and restrictions and b)fear that I will have experienced another failed trial. I wish I had a crystal ball.Please convince me why you would try the nortrip. and the nardil. I am trying to research as much as I can but I wind up even more confused.
I truly hope this is the med for you Scott and I wish you good days ahead.
Nicole
Posted by T-rotten on September 7, 2004, at 17:57:05
In reply to Re: what is Milnacipran? » T-rotten, posted by SLS on September 7, 2004, at 17:37:19
> > Well 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.
>
>
> Hi T.
>
> Are you still taking Ixel? What side effects did you experience?
>
> Thanks.
>
>
> - ScottYes, I am using it with Pamelor. As I changed from paroxetine to ixel, I havent felt any extra side effect. Maybe a little more agitated, but more energic and active, so the good effects hidden the bad, and the clonazepam helped too.
But my pdoc said that the others that gone to Ixel had minimal side effects comparing with the improvments.
Before it, I've tried the paroxetine with reboxetine but it didnt work. I can say that milnacipran is very good, even better than effexor!
Tanks.
Posted by KaraS on September 7, 2004, at 18:06:25
In reply to Re: Cymbalta (duloxetine) - report » KaraS, posted by SLS on September 7, 2004, at 8:10:56
> 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
>
>Dear Scott,
I completely understand. My apartment is a nightmare and my "to do" lists are miles long. Wish I had a magic wand to give us both our motivation back but for now all I can offer are some interesting links on inflammation and depression from "raybakes":
"Found an article on depression and inflammation - that seems to be the core of what has helped me, doing everything I can to get inflammation down!
also found this with interleukin 1 and it's possible link with hashimoto's
http://www.annalsnyas.org/cgi/content/abstract/876/1/221
Antimicrobial and immunoregulatory functions of lactoferrin and its potential therapeutic application.
Take care,
KaraP.S. Hope I didn't insult you with my comments on exercise.
Posted by SLS on September 7, 2004, at 18:51:41
In reply to Re: Milnacipran » SLS, posted by nmk on September 7, 2004, at 17:38:50
Hi again.
> > I would have thought Yasmin to be the better choice for PMDD
> He did try me on Yasmin but the progestin in the pill sent me spiraling downward into a serious depression.
I knew that was a possibility, but I thought it was less so with drospirenone. Darn.
> Please convince me why you would try the nortrip. and the nardil.
I think I would ask the doctor why he chose clomipramine over the other TCAs. His reasons might be compelling. Nortriptyline and desipramine do have milder side effect profiles. Clomipramine is sort of a cross between imipramine (from which it is derived) and an SSRI, and has the side effects of both. I'm sure your doctor wants to give you the best possible chance of responding to treatment. The question comes down to whether or not you would prefer to try first the drug with the fewer side effects before moving on to one with increased side effects, but with perhaps a higher probability of working.
Parnate is generally more forgiving than Nardil regarding side effects. It produces less problems with hypotension and anorgasmia, and is easier on the liver. Nardil can also produce edema. Although both MAOIs are capable of treating both depression and anxiety, Nardil seems to be more effective for the latter. Parnate can sometime exacerbate anxiety and agitation because of its stimulant properties. Ask your doctor what he thinks about this.
> I am trying to research as much as I can but I wind up even more confused.
Instead of using this information to make a decision in the absence of your doctor, perhaps it would be better to use it to discuss with him his reasons for choosing certain drugs versus the advantages and disadvantages of the others you have researched. You might end up agreeing with his choices. For instance, his reason for choosing clomipramine might be because he feels that you were partially responsive to SSRIs. Hopefully, he will be able to clear up any confusion.
- Scott
Posted by Cecilia on September 8, 2004, at 1:55:50
In reply to Milnacipran » SLS, posted by iris2 on September 7, 2004, at 9:17:51
I would also be interested in your experience with Milnacipran. That was the next thing I planned to try, but then duloxetine was actually approved (never thought it would be) so I guess I`ll go for that 1st, since it`s available here (U.S.) and insurance will cover it. Right now I`m still on a trial of tianeptine-zero effects, side or otherwise, after 2 months. Who knows what I`m doing to my brain-the tianeptine supposedly decreases serotonin, then I`ll go on the duloxetine and increase it again. I`m just so terrified of starting the duloxetine, because effexor had the worst side effects of of all the many many meds I`ve tried. Cecilia
Posted by iris2 on September 8, 2004, at 8:28:56
In reply to Re: Milnacipran » iris2, posted by SLS on September 7, 2004, at 16:03:26
Scott,
I did try and remember why. I tried to get my pdoc to take a gander and he was not interested. I think one reason was that the Duloxetine was new and I have been a "guini pig" too many times.Beyond that it was my crystal ball and then the coin toss. Not a lot of thought at least to make the final decition.
Thanks though, I need a push sometimes or I get lazy. This time I spent a long time and just could not come up with any real particular reason why one would be better to try over the other.
By the way how's it going for you? Last I read you were going to stay with the Cymalta for a full trial but did not seem very hopefull. I hope it turns around for you. I cannot remember, are you augmenting it with anythng in particular?
I started this with amisulpride which is helping some but I am limited as it is affecting my bladder. I have found it difficult to take almost any medication so the last couple of years were kind of constant suicide thought with no hope at all. I just decided to try it all again but there is always a good chance I wil not be able to take a med even if it seems to work.irene
Posted by iris2 on September 8, 2004, at 8:41:49
In reply to Re: what is Milnacipran?, posted by T-rotten on September 7, 2004, at 17:20:16
Thanks for some personal information about the Ixel. I started it today and have not read about anyone who has tried it.
irene
Posted by nmk on September 8, 2004, at 10:12:29
In reply to Re: Milnacipran » nmk, posted by SLS on September 7, 2004, at 18:51:41
Thanks for all of the advice, I do appreciate it. I meet with my doc at the end of the month and I will raise these questions with him.
Please keep the updates coming and I wish you the best.
Nicole
Posted by aloe on September 8, 2004, at 11:23:08
In reply to Re: Cymbalta (duloxetine) - report, posted by awatts on September 4, 2004, at 14:36:47
I'll be checking in, too, for updates on others Cymbalta experiences, and to leave reports on my own. I am starting Cymbalta today, with the hope that the sexual side effects won't be as bad as with others. I just hope this isn't another case of the Lexapro debacle, where the manufacturer hypothesizes that the sexual side effects will be minimal, despite the fact that it has the same active ingredient as Celexa. I wouldn't think it would be any surprise that Lexapro showed the same sexual effects as Celexa.
The insert that comes with Cymbalta may also be constructed to "disguise" some of the sexual side effects. If you look, instead of having just one category for "sexual side effects", the insert separates into their own categories the following dysfunctions: Orgasm abnormal, ejaculatory dysfunction, libido decreased, erectile dysfunction, ejaculation delayed. That way when you see 2% for one category you think, "Oo! Only a 2% chance of abnormal orgasms. That doesn't sound too bad compared to Celexa's (or any other SSRI's) 30% chance of general sexual dysfunction." But add up the numbers in Cymbalta's categories and suddenly you've got a number larger then 2%.
Also noticeable from the package insert is that sexual dysfunction was much more prevalent in males. Sorry guys.
I don't know how much I believe these package inserts,though. I have experience in the science field, and I am well aware of how numbers can have various interpretations depending on which biased eye is looking at them. Plus, the trials used to acquire the numbers aren't as free from variables as the people conducting the studies like to think they are.
I'd better stop now. Sorry if I just bored you all to death.
> 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 4WD on September 8, 2004, at 13:58:33
In reply to Re: what is Milnacipran? » SLS, posted by Racer on September 7, 2004, at 15:44:08
> 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 ;-)
Racer,Sorry to butt in but I wanted to tell you that I was experiencing a lot of anxiety and grim/bleak outlook the last couple of days on Cymbalta. After looking back through my calendar, I realized that I had felt the same way when I switched from Effexor to Wellbutrin and from Effexor to Paxil. It occurred to me that just maybe the Wellbutrin and the Paxil hadn't made me so anxious and bad-feeling. Maybe it was the Effexor withdrawal. So the last couple of days, I've added a small amount of Effexor back in (in addition to the Cymbalta) and I am feeling much much better today. I don't know what you were on before but could it be possible the agitation, etc is a reaction to d/cing the previous med?
marsha
Posted by jrbecker on September 8, 2004, at 14:19:50
In reply to Re: Cymbalta (duloxetine) - report, posted by aloe on September 8, 2004, at 11:23:08
> I'll be checking in, too, for updates on others Cymbalta experiences, and to leave reports on my own. I am starting Cymbalta today, with the hope that the sexual side effects won't be as bad as with others. I just hope this isn't another case of the Lexapro debacle, where the manufacturer hypothesizes that the sexual side effects will be minimal, despite the fact that it has the same active ingredient as Celexa. I wouldn't think it would be any surprise that Lexapro showed the same sexual effects as Celexa.
>
> The insert that comes with Cymbalta may also be constructed to "disguise" some of the sexual side effects. If you look, instead of having just one category for "sexual side effects", the insert separates into their own categories the following dysfunctions: Orgasm abnormal, ejaculatory dysfunction, libido decreased, erectile dysfunction, ejaculation delayed. That way when you see 2% for one category you think, "Oo! Only a 2% chance of abnormal orgasms. That doesn't sound too bad compared to Celexa's (or any other SSRI's) 30% chance of general sexual dysfunction." But add up the numbers in Cymbalta's categories and suddenly you've got a number larger then 2%.
>
> Also noticeable from the package insert is that sexual dysfunction was much more prevalent in males. Sorry guys.
>
> I don't know how much I believe these package inserts,though. I have experience in the science field, and I am well aware of how numbers can have various interpretations depending on which biased eye is looking at them. Plus, the trials used to acquire the numbers aren't as free from variables as the people conducting the studies like to think they are.
>
> I'd better stop now. Sorry if I just bored you all to death.
>
> > 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.
>If it's any consolation, both Celexa, and Lexapro (a little less so), left me numb. Even at minute doses, I had extreme anorgasmia.
Effexor was a little better for me sexually (both libido and orgasmically, but not much).
Cymbalta has been a pleasant surprise so far. I experience little dysfunction and have a slightly increased libido compared to when I was on Effexor. But I should note that I am currently only taking 30mg daily.
Posted by iris2 on September 8, 2004, at 22:09:35
In reply to Re: Cymbalta (duloxetine) - report » iris2, posted by SLS on September 7, 2004, at 9:27:54
Hi Scott,
Thanks. I have been posting more often.
It is great that you are here.
Well you do a lot of work here so I would not say you are not working :) :)irene
Posted by Nohope on September 9, 2004, at 3:57:06
In reply to Re: what is Milnacipran?, posted by SLS on September 7, 2004, at 13:09:05
> 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.
>
>
> - ScottI was on milnacipran for a few months earlier this year (dose varied: 75-150mg).
I found it extremely tolerable. Some annoying start up side effects such as insomnia and nausea, but these passed. Very few side effects remained after 2-3 weeks.
For me, it was more potent as an antidepressant than the SSRIs, but that's not really surprising since I don't respond well to SSRIs. Unfortunately, it had no effect on my very strong fatigue (atypical depression guy here...) and I could only work and sleep, so I had to ditch it. It was moderately effective for my panic.
There is a rather large study suggesting that milnacipran was similar in efficacy to imipramine and superior to fluvoxamine. Maybe it's true, but I've never taken imipramine, so I can't say for sure (anyway, I am only a sample size of n=1).
Overall, it was definitely better than nothing and very tolerable, but not good enough for me.
(BTW check out its structure: hauntingly similar to Parnate)
Nohope
Posted by Minnie-Haha on September 9, 2004, at 15:18:22
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by KaraS on September 7, 2004, at 18:06:25
> "Found an article on depression and inflammation - that seems to be the core of what has helped me, doing everything I can to get inflammation down!
>
> http://66.102.9.104/search?q=cache:49TDZcsEWEQJ:www.medscape.com/viewarticle/438509+depression+interleukin+1+new+scientist&hl=en&ie=UTF-8
>
> also found this with interleukin 1 and it's possible link with hashimoto's
>
> http://www.annalsnyas.org/cgi/content/abstract/876/1/221
>
> Antimicrobial and immunoregulatory functions of lactoferrin and its potential therapeutic application.
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12542852
>
>
> Take care,
> KaraSomebody out there who can tell me what these reports mean? I tried to read 'em, but fell down mentally. I have thyroid nodules, was briefly treated with a synthetic thyroid hormone (to try to shrink the nodules), but had to stop because it pushed me into a hyperthyroid state and with my months-long battle with insomnia, anxiety, and depression, I just could tolerate increasing those symptoms. I don't have fibrolyalgia, but the rheumatologist said I have enough symptoms of that to warrant taking a small dose of a TCA at night to see if it helps me sleep (and thereby improves my mood). I just keep feeling like there's a hormonal or inflammatory or some kind of systemic answer like that to the puzzle, though tests have turned up nothing yet.
Posted by Minnie-Haha on September 9, 2004, at 15:31:22
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 7, 2004, at 8:50:27
> I still think Cymbalta will be a great drug for many people. I would not discourage anyone from trying it at this point.
>
> - ScottI just spent an hour or more following this thread and I want to thank you for taking the time to share your recent experiences with Cymbalta, as well as just your general knowledge, care, concern, etc. My doctor recommended Cymbalta today, but I told him I wanted to learn more about it. My official DX are BP2 and OCD, but I'm not sure they're correct. At any rate, my main complaints this past year have been insomnia, anxiety, and depression. My old pdoc didn't want to give me anti-depressants, so I've been muddling through with Trileptal and Ativan. The new pdoc suggested the Cymbalta, but also said my PCP's idea to try a low dose of Elavil at night might be worth a try, to see if it helps me sleep and see if that in turn improves my mood. (I briefly tried Ambien, once again just to see if sleep alone would improve my mood, but after a couple of nights, it didn't really help me sleep through and my daytime mood went in the toilet.) I think I will try the Elavil for a while, but if no real improvement, perhaps I'll give Cymbalta a go.
Thanks again.
Posted by SLS on September 9, 2004, at 16:27:53
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 7, 2004, at 8:50:27
9/9/2004
Day 21
6 days at 30mg
14 days at 60mg60mg (30mg b.i.d.)
Oh, well. I wish I could say that I am at all improved right now, but I really can't. I was feeling better a week ago.
I am not experiencing any physical or cognitive side effects at the moment.
- Scott
Posted by pseudonym on September 10, 2004, at 0:53:33
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 9, 2004, at 16:27:53
Why are you taking it twice daily? I thought that Lilly recommeded one daily @ 60 mg.
Posted by alesta on September 10, 2004, at 1:12:10
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 9, 2004, at 16:27:53
hi, scott,
i don't know if you didn't see my question before, but i was wondering how you did on parnate and/or nardil???
amy:)
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