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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 168 to 192 of 335. Go back in thread:
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:)
Posted by SLS on September 10, 2004, at 7:10:23
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by alesta on September 10, 2004, at 1:12:10
Hi Amy.
> i don't know if you didn't see my question before, but i was wondering how you did on parnate and/or nardil???
The only thing that ever worked for me was a combination of Parnate + desipramine. Unfortunately, my doctor at the time discontinued it and I never responded to it again. I am partially responsive to Nardil, but not enough to stay on it.Thanks.
- Scott
Posted by SLS on September 10, 2004, at 7:16:54
In reply to Re: Cymbalta (duloxetine) - report, posted by pseudonym on September 10, 2004, at 0:53:33
> Why are you taking it twice daily? I thought that Lilly recommeded one daily @ 60 mg.
Hi P.
I have 30mg capsules, so I figured I'd follow a b.i.d. schedule given the short half-life.
This is how the manufacturer suggests dosing:
"Cymbalta should be administered at a total dose of 40 mg/day (given as 20 mg BID) to 60 mg/day (given either once a day or as 30 mg BID) without regard to meals."
I'll think about trying the 60mg in the morning. I guess it's possible that it might be more effective. You never know. I sort of doubt it, though. I think Lilly might be suggesting the once-daily dosing as convenience measure to help sell the product.
- Scott
Posted by alesta on September 10, 2004, at 17:06:33
In reply to Re: Cymbalta (duloxetine) - report » alesta, posted by SLS on September 10, 2004, at 7:10:23
thanks for your reply, scott..i appreciate it..have you tried magnesium supplementation with quality supplements, and have you had your hormone and thyroid levels checked? (guys can have hormone problems, too..) i ask all these questions b/c i don't think a depression gene has yet been identified, so i am trying to look at all the possible factors that might contribute to your depression, since you are so treatment-resistant..i also posted a thread "ppl with treatment-resistant depression or any depression please read". i had you in mind when i posted it..please get back to me...:)
amy:)
Posted by Minnie-Haha on September 10, 2004, at 17:23:14
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by alesta on September 10, 2004, at 17:06:33
> i also posted a thread "ppl with treatment-resistant depression or any depression please read". i had you in mind when i posted it..please get back to me...:)
>
> amy:)so where is this post? i can't find it.
Posted by alesta on September 10, 2004, at 17:40:12
In reply to Re: Cymbalta (duloxetine) - report, posted by Minnie-Haha on September 10, 2004, at 17:23:14
hi, minnie:),
this should be the link:
http://www.dr-bob.org/babble/20040904/msgs/387334.html
amy;
Posted by SLS on September 10, 2004, at 17:47:19
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by alesta on September 10, 2004, at 17:06:33
Hi Amy.
Thanks for trying so hard.
:-)
I really do appreciate it. I hope I can make it up to you somehow.
I read the piece on magnesium about 1½ years ago. I gave it a try. It made me sleepy, but that's about it. It was well worth the try, though. A few people here reported great success with it.
I have added both T3 and T4 thyroid hormones to my treatment, despite testing normal. T4 helped a little bit initially, but not enough to stick with.
I have only tried a few of the alternative treatments - magnesium, fish oil, inositol, S-AMe, tyrosine, vitamins, and a few others. I just don't get the feeling that's where my answer lies. I try to keep an open mind, though. I take a peek at the alternative board every now and then. There are so many different "supplements" discussed, it's hard to keep up with.
- Scott
Posted by alesta on September 10, 2004, at 18:16:11
In reply to Re: Cymbalta (duloxetine) - report » alesta, posted by SLS on September 10, 2004, at 17:47:19
you're most welcome, scott..:)..i'm sorry i can't be of more help...it must be awful to feel as you do day in and day out..
i wonder if there is a blood test you could take to figure out the levels of various vitamins in your body. also, there is a saliva test to check hormone levels...
anyway, hope you can find a solution..you are still a charming presence..even depressed..:)
take care :),
amy
Posted by SLS on September 13, 2004, at 7:26:04
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 9, 2004, at 16:27:53
9/13/2004
Day 25
6 days at 30mg
19 days at 60mg60mg (30mg b.i.d.)
No improvement. I don't anticipate the reappearance of the antidepressant response I experienced two weeks ago.
No side effects with the possible exception of a reduction of libido. It is difficult to tell because the depression itself might be causing it. I'm also pretty bummed-out about things right now, so I suppose that could account for it.
I hope others will do well on this drug. The reports being posted are encouraging.
- Scott
Posted by jrbecker on September 13, 2004, at 11:06:44
In reply to Re: Cymbalta (duloxetine) - day 10, posted by jrbecker on September 2, 2004, at 12:26:28
here's my 3rd report....
30mg daily, in AM.
I've learned to keep my expectations low with any new drug trial, but I've been pleasantly surprised at my slow but sure progress these last few weeks.
Some mild sleepiness throught the first 3-7 hours after dosing. Anxiety is nil, agitation neglible, irritabilty very little, a noticable delayed orgasm (beats the total anorgasmia I have on other meds), but it hasn't put a damper on my libido. This is a side effect profile that has been unbelievable charitable so far in comparison to the other SSRI/SNRIs.
Socializing more, exercising more and generally less hypervigilint.
JB
> here's my 2nd report...
>
> still taking 30mg in the morning. as far as side effects, some slight sleepiness throughout the early part of the day and some very mild sleep disruption a few nights. As for the daytime sleepiness, I'd guess that it's gotten about 50% better since I started, so this is hopefully good news for most of you.
>
> I have noticed a gradual improvement of my affect anxiety, and motivation in this last week and a half -- nothing phenomenal but definitely significant.
>
> Dare I up it 40mg? I think the deicision will rest on whether the 20mg tablets will be available to me anytime soon. My main concern in doing this would be any increase in apathy that might go along with it. But so far, I've felt more motivated than compared with my old dose of effexor, so maybe an increase might help rather than hinder my inner drive.
>
> Developing....
>
>
>
>
>
>
> > here's my first report...
> >
> > taking 30mg once daily in the morning. only side effects are some mild somnolence about 3-6 hours after dosing. Some nights, I have experienced a little sleep disruption and initial insomnia on some nights. But I've been able to still make it to the gym, so I can't say that there's been any decrease in my overall enegry level. To my relief, I have not experienced any increase in anxiety or agitation. As Scott mentioned, the drug is rather "clean."
> >
> > So far, I must admit that this is a welcomed improvement over my prior regimen of Effexor 37.5mg.
> >
> > I plan to stick with 30mg for a couple more weeks.
> >
> > I haven't ruled out upping to 40mg (20mg BID) or even decreasing to 20mg. As you might guess, I'm fairly med sensitive.
> >
> > JB
> >
>
>
Posted by 4WD on September 13, 2004, at 21:01:05
In reply to Re: Cymbalta (duloxetine) - day 21, posted by jrbecker on September 13, 2004, at 11:06:44
> here's my 3rd report....
>
> 30mg daily, in AM.
>
> I've learned to keep my expectations low with any new drug trial, but I've been pleasantly surprised at my slow but sure progress these last few weeks.
>
> Some mild sleepiness throught the first 3-7 hours after dosing. Anxiety is nil, agitation neglible, irritabilty very little, a noticable delayed orgasm (beats the total anorgasmia I have on other meds), but it hasn't put a damper on my libido. This is a side effect profile that has been unbelievable charitable so far in comparison to the other SSRI/SNRIs.
>
> Socializing more, exercising more and generally less hypervigilint.
>
> JB
>
> > here's my 2nd report...
> >
> > still taking 30mg in the morning. as far as side effects, some slight sleepiness throughout the early part of the day and some very mild sleep disruption a few nights. As for the daytime sleepiness, I'd guess that it's gotten about 50% better since I started, so this is hopefully good news for most of you.
> >
> > I have noticed a gradual improvement of my affect anxiety, and motivation in this last week and a half -- nothing phenomenal but definitely significant.
> >
> > Dare I up it 40mg? I think the deicision will rest on whether the 20mg tablets will be available to me anytime soon. My main concern in doing this would be any increase in apathy that might go along with it. But so far, I've felt more motivated than compared with my old dose of effexor, so maybe an increase might help rather than hinder my inner drive.
> >
> > Developing....
> >
> >
> >
> >
> >
> >
> > > here's my first report...
> > >
> > > taking 30mg once daily in the morning. only side effects are some mild somnolence about 3-6 hours after dosing. Some nights, I have experienced a little sleep disruption and initial insomnia on some nights. But I've been able to still make it to the gym, so I can't say that there's been any decrease in my overall enegry level. To my relief, I have not experienced any increase in anxiety or agitation. As Scott mentioned, the drug is rather "clean."
> > >
> > > So far, I must admit that this is a welcomed improvement over my prior regimen of Effexor 37.5mg.
> > >
> > > I plan to stick with 30mg for a couple more weeks.
> > >
> > > I haven't ruled out upping to 40mg (20mg BID) or even decreasing to 20mg. As you might guess, I'm fairly med sensitive.
> > >
> > > JB
> > >
> >
> >
>JB
I am so happy for you. Cymbalta is treating me pretty well, too. (30mg day) tapering Effexor, Klonopin as needed for anxiety.
How are you tapering your Effexor? What was your dose? I am finding that coming off the Effexor is making me very anxious, necessitating the Klonopin. Perhaps I am trying to taper too fast? Have you experienced any ringing in your ears or pressure in your head?
Marsha
>
Posted by 4WD on September 13, 2004, at 21:19:19
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 13, 2004, at 7:26:04
> 9/13/2004
>
> Day 25
>
> 6 days at 30mg
> 19 days at 60mg
>
> 60mg (30mg b.i.d.)
>
> No improvement. I don't anticipate the reappearance of the antidepressant response I experienced two weeks ago.
>
> No side effects with the possible exception of a reduction of libido. It is difficult to tell because the depression itself might be causing it. I'm also pretty bummed-out about things right now, so I suppose that could account for it.
>
> I hope others will do well on this drug. The reports being posted are encouraging.
>
>
> - ScottScott I am sorry it isn't working for you. I wish so much you could find something that would do it for you. I know people probably give you all sorts of suggestions - I don't have any. But I will pray for you.
Marsha
Posted by pseudonym on September 13, 2004, at 23:13:25
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 13, 2004, at 7:26:04
From a prior post you mentioned you were using Abilify as anti-depressant,correct, not as an anti-psychotic, or at least to keep you from the "abyss". If that is correct, what is life like for you without Abilify?
Posted by karaS on September 14, 2004, at 0:39:20
In reply to Re: Cymbalta (duloxetine) - report, posted by Minnie-Haha on September 9, 2004, at 15:18:22
> > "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,
> > Kara
>
> Somebody 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.
>I didn't even try to read them. I just forwarded them to Scott because I thought they were about something he had been looking into. Sorry.
-K
Posted by SLS on September 14, 2004, at 6:31:32
In reply to Re: Cymbalta (duloxetine) - report, posted by 4WD on September 13, 2004, at 21:19:19
Thanks, Marsha.
:-)
- Scott
Posted by SLS on September 14, 2004, at 6:37:59
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by pseudonym on September 13, 2004, at 23:13:25
> From a prior post you mentioned you were using Abilify as anti-depressant,correct, not as an anti-psychotic, or at least to keep you from the "abyss". If that is correct, what is life like for you without Abilify?
Hi P.
I skipped taking Abilify for a few days last week to see if I could do without. I experienced a small worsening of depression and the appearance of anxiety. It was enough of a worsening that I decided to go back on it. Lamictal + TCA + Abilify give me about a 15% improvement over my unmedicated baseline. I would want to give you more detail as to just what that baseline is like to live with, but I would find it a bit too upsetting to write about right now. When I'm up to it, I'll try to fill you in.
- Scott
Posted by ravenstorm on September 14, 2004, at 9:00:56
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 13, 2004, at 7:26:04
Scott-you are only on day 25, don't despair yet!! It may take eight to twelve weeks and you are only on week three to four. I know its hard but don't give up yet. Remember the guy who posted it took 45 days for Lexapro to kick in for him?
Posted by jrbecker on September 14, 2004, at 9:43:49
In reply to Re: Cymbalta (duloxetine) - day 21 » jrbecker, posted by 4WD on September 13, 2004, at 21:01:05
> JB
>
> I am so happy for you. Cymbalta is treating me pretty well, too. (30mg day) tapering Effexor, Klonopin as needed for anxiety.
>
> How are you tapering your Effexor? What was your dose? I am finding that coming off the Effexor is making me very anxious, necessitating the Klonopin. Perhaps I am trying to taper too fast? Have you experienced any ringing in your ears or pressure in your head?
>
> Marsha
>
>Marsha-
sorry to hear that the transition is not going smoothly.
I actually did not taper over from effexor. I just thought that the transition from 37.5 of effexor to 30mg of cymbalta would be a fairly easy transition. For me it was, luckily. But my doc had recommended a cross-taper of a week or so.
In your case, I think it's probably hard to distinguish the effexor withdrawal effects from the cymbalta start-up effects. I would assume that it would be more of the latter. I'd stick to your plan to cross-taper conservatively, using the benzo at as low of a dose that you feel comfortable with. I think you're out of the worst of it.
As for pressure in the head, or ringing in my ears, no, I haven't experienced either.
Good luck.
JB
Posted by flipsactown on September 14, 2004, at 10:36:05
In reply to Re: Cymbalta (duloxetine) - report, posted by ravenstorm on September 14, 2004, at 9:00:56
That was me and I am still depression free over 3 months now on Lexapro. Yes, patience is a virtue. I am hoping that Cymbalta will kick in for you soon, Scott.
A Concerned Friend and Poster,
FST> Scott-you are only on day 25, don't despair yet!! It may take eight to twelve weeks and you are only on week three to four. I know its hard but don't give up yet. Remember the guy who posted it took 45 days for Lexapro to kick in for him?
Posted by 4WD on September 14, 2004, at 13:54:41
In reply to Re: Cymbalta (duloxetine) - report, posted by ravenstorm on September 14, 2004, at 9:00:56
> Scott-you are only on day 25, don't despair yet!! It may take eight to twelve weeks and you are only on week three to four. I know its hard but don't give up yet. Remember the guy who posted it took 45 days for Lexapro to kick in for him?
That's right! And Lexapro is suppose to be one of the faster acting ones also.
Go forward in thread:
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