![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 176 to 200 of 335. Go back in thread:
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.
Posted by SLS on September 14, 2004, at 14:31:22
In reply to Re: Cymbalta (duloxetine) - report, posted by 4WD on September 14, 2004, at 13:54:41
> > 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.
Thanks everyone. :-)I'll remain cautiously hopeful and try not to pronounce judgment on Cymbalta so quickly. I intend to continue with it for at least another 6 weeks.
- Scott
Posted by yznhymer on September 14, 2004, at 20:14:34
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 14, 2004, at 14:31:22
Scott,
Thanks for sharing your Cymbalta journey with us. I have been reading your postings and those of others with great interest.
I may be starting a course of Cymbalta in the near future. I have been taking moclobemide and, while the side effects are nil the benefits have been unremarkable. Furthermore, my new psychiatrist is suddenly "uncomfortable" prescribing moclobemide any more. So its on to another med.
I've been in an intimate relationship with depression for about 3 decades now and have tried many of the antidepressants out there. The results were either lack of response or an unacceptable cluster of side effects... more often than not I'd get the side effects and no relief.
This month I'm weaning off the moclobemide. That's really an overstatement because I've had no withdrawal issues whatsoever. My doc has mentioned two possibilities to replace moclobemide: Cymbalta or Lactimal.
From my reading, the Emsam patch(selegeline)might also hold some promise, though best case scenario seems to be an early 2005 release for that med. I'm wondering if its worth a go on an oral administration in the meantime?
What I know about my depression at this point is that its pretty clearly a case of dysthymia... and atypical. Not so much a case of the blues (in fact,my sense of humor is quite active most of the time)or feeling suicidal (though I've been there in the past)but a total lack of energy, motivation, and the ability to enjoy things. Fatigue, anxiety, and weight gain are the order of the day.
Of all the meds I've tried, Nardil stands alone in providing truly remarkable relief of these depressive symptoms. Normally socially anxious and introverted, I felt positively gregarious when taking it. Unfortunately, I gained 20 pounds the first 4 weeks and lost ability to function sexually. A future as a fat impotent began to look pretty depressing in and of itself. So, with some reluctance, I moved on.
One of the reasons I tried the moclobemide was to recapture the MAOI benefits... but no dice. Perhaps the emsam patch or orally administered selegeline might be the ticket. With a lot of luck maybe I'll get the benefits without a nasty side effect cluster. I plan to throw that option into the discussion when I meet with my pdoc in a couple of weeks. I don't know how he'll respond... he's still a new entity to me and I don't feel a good connection with him.
If anybody has any thoughts about the way to go between Cymbalta, selegeline or lamactil at this juncture, I'd be grateful for hear them. My best to all of you out there.
Mark
Posted by iris2 on September 14, 2004, at 22:37:05
In reply to Re: Cymbalta (duloxetine) - report, posted by yznhymer on September 14, 2004, at 20:14:34
Just a thought. With good response to Nardil, have you ever tried Parnate or Marplan? I had a good response to them and not Nardil with slight response to Moclobimide. Someone on this sight mentioned that chemically Cymbalta was close to Parnate. Do not know if it is true or if it is of any significance.
I've had about three decades of atypical depression myself and tried a variety of meds with about the same results as you. As an adjunct to Parnate or Moclobimide I was on reboxetine and ritalin. I tried Selegaline with no patch. No go!
Maybe this will help a little.
irene
Posted by yznhymer on September 15, 2004, at 4:02:09
In reply to Re: Cymbalta (duloxetine) - report » yznhymer, posted by iris2 on September 14, 2004, at 22:37:05
> Just a thought. With good response to Nardil, have you ever tried Parnate or Marplan? I had a good response to them and not Nardil with slight response to Moclobimide. Someone on this sight mentioned that chemically Cymbalta was close to Parnate. Do not know if it is true or if it is of any significance.
>
> I've had about three decades of atypical depression myself and tried a variety of meds with about the same results as you. As an adjunct to Parnate or Moclobimide I was on reboxetine and ritalin. I tried Selegaline with no patch. No go!
>
> Maybe this will help a little.
>
> ireneThanks Irene. I appreciate the input. Never have tried Parnate or Marplan. I believe my doc's thinking was that the odds of the side effects being similar to Nardil were pretty great. I'd have to agree that if the potential for sexual dysfunction is possible, I'm likely to get hit with it. From what I've read, Selegeline might be a little more forgiving in this department, as well as have some efficacy with the types of symptoms I experience, that is, if it works at all. Likewise, I've read that Cymbalta may not be so harsh in terms of sexual dysfuction as a side effect and may offer greater efficacy than a pure SSRI. In both cases there's only one way to find out, right?
Neither of the pdoc's I've had were willing (able?)to augment moclobemide. Roche Canada refused to give my current pdoc any info when he called (I'm in the states). I did augment moclobemide with DHEA for awhile while involved in a rigorous exercise program... the DHEA and exercise made a BIG difference. Since I've moved, dropped the personal trainer and slid into this slump, I've not been able to muster the motivation and stamina to get a good exercise program going again, though its still a goal! Hmmm... maybe I should restart the DHEA in any event.
Best wishes, Irene, and other posters...
Mark
Posted by SLS on September 15, 2004, at 7:58:53
In reply to Re: Cymbalta (duloxetine) - report, posted by yznhymer on September 15, 2004, at 4:02:09
Hi Mark.
Welcome to Psycho-Babble and thank you for the great introduction.
I agree with Irene in suggesting Parnate. Parnate is much less likely than Nardil to produce either weight gain or sexual dysfunction. If anything, you might experience an abnormal orgasm for the first few weeks, but it dissipates, and both erectile and orgasmic function are left intact. I would say that oral selegiline is likely to be a waste of time. The patch seems to be significantly more effective. Still, I would place Parnate higher on the list if you are willing to deal with the dietary restrictions.
Cymbalta might be a logical choice at this juncture. Only one person has reported anorgasmia so far of the 8 or so people taking it here on Psycho-Babble. It hasn't affected me in the slightest. The side effect profile for Cymbalta seems to be less pronounced than for Effexor. Weight gain doesn't yet seem to be an issue. If you want a better idea as to how Cymbalta treats people long-term, I'm afraid you'll have to speak to a clinical investigator or wait and watch.
Lamictal by itself rarely does the trick. Many people experience a transient improvement within the first few weeks at dosages as low as 50mg, only to find it fade over time. 200mg seems to be the average effective dosage for depression, but I doubt you will achieve full remission in the absence of another antidepressant medication. The rate at which one can increase the dosage of Lamictal to a therapeutic level is very slow. The gradual titration is necessary to prevent a serious adverse reaction that includes a rash. Steven's Johnson syndrome can be a consequence of too fast a titration. It might be as long as 6 weeks before you reach 200mg.
You must take any advice given here with a grain of salt; not so much because of any inaccuracies that might be stated, but because everyone reacts so differently to treatment. For instance, you might be one of the few people for whom Lamictal monotherapy might be effective.
By the way, although you might indeed have dysthymia, I wouldn't endorse a diagnosis based upon the absence of depressed mood or sadness. Loss of interest and motivation is an equally valid criterion. Depressed mood is not a feature of my condition, yet my depression is quite severe.
Good luck with your treatment. Given your robust response to Nardil, I'm sure you will find something else that will work. I should mention that many people who experience anorgasmia with Nardil in the beginning of treatment find that their ability to orgasm returns after 3 months.
- Scott
Posted by iris2 on September 15, 2004, at 8:20:18
In reply to Re: Cymbalta (duloxetine) - report, posted by yznhymer on September 15, 2004, at 4:02:09
I am curious about the DHEA? I cannot remember much about it. Can you expound a little.
My observation is that Nardil tends to cause more of a weight gain problem while Parnate, Marplan and Mocolobimide (a reversible MAOI) do not. Probably the Parnate and Marplan (at least for me they did) have sexual side effects. My depression is so bad I do not care much about that at least not at first. It is when I am feeling better because of the Parnate/Marplan that I feel like I want to have a sex life. Dam*** if you do and if you don't.If you have a particular interest in Moclobimide I certainly can get any information you might want. My pdoc, did several years of research with Moclobimide to get it FDA approved. He contends it was not approved because there was not a large enough market for it. Anyway he would have first hand knowledge of it all.
Best of luck. Keep us posted.
irene
Posted by iris2 on September 15, 2004, at 10:11:57
In reply to Re: Cymbalta (duloxetine) - report » iris2, posted by yznhymer on September 15, 2004, at 10:04:34
One of the meds I augmented it with was Reboxetine.
Bythe way all of the MAOI's gave me acne. So maybe is was the MOclobimide?
Thanks for the link.
irene
Posted by yznhymer on September 15, 2004, at 10:54:45
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 15, 2004, at 7:58:53
> Hi Mark.
>
> Welcome to Psycho-Babble and thank you for the great introduction.
>
> I agree with Irene in suggesting Parnate. Parnate is much less likely than Nardil to produce either weight gain or sexual dysfunction. If anything, you might experience an abnormal orgasm for the first few weeks, but it dissipates, and both erectile and orgasmic function are left intact. I would say that oral selegiline is likely to be a waste of time. The patch seems to be significantly more effective. Still, I would place Parnate higher on the list if you are willing to deal with the dietary restrictions.
>
> Cymbalta might be a logical choice at this juncture. Only one person has reported anorgasmia so far of the 8 or so people taking it here on Psycho-Babble. It hasn't affected me in the slightest. The side effect profile for Cymbalta seems to be less pronounced than for Effexor. Weight gain doesn't yet seem to be an issue. If you want a better idea as to how Cymbalta treats people long-term, I'm afraid you'll have to speak to a clinical investigator or wait and watch.
>
> Lamictal by itself rarely does the trick. Many people experience a transient improvement within the first few weeks at dosages as low as 50mg, only to find it fade over time. 200mg seems to be the average effective dosage for depression, but I doubt you will achieve full remission in the absence of another antidepressant medication. The rate at which one can increase the dosage of Lamictal to a therapeutic level is very slow. The gradual titration is necessary to prevent a serious adverse reaction that includes a rash. Steven's Johnson syndrome can be a consequence of too fast a titration. It might be as long as 6 weeks before you reach 200mg.
>
> You must take any advice given here with a grain of salt; not so much because of any inaccuracies that might be stated, but because everyone reacts so differently to treatment. For instance, you might be one of the few people for whom Lamictal monotherapy might be effective.
>
> By the way, although you might indeed have dysthymia, I wouldn't endorse a diagnosis based upon the absence of depressed mood or sadness. Loss of interest and motivation is an equally valid criterion. Depressed mood is not a feature of my condition, yet my depression is quite severe.
>
> Good luck with your treatment. Given your robust response to Nardil, I'm sure you will find something else that will work. I should mention that many people who experience anorgasmia with Nardil in the beginning of treatment find that their ability to orgasm returns after 3 months.
>
>
> - ScottScott,
Thanks for the welcome! I appreciate your insights and encouraging words. I'm sort of in an interesting place dealing with this. In recent years I've just been grateful that the really black suicidal episodes have abated. I sort of settled into a chronic low level depressive state. Having exhausted the usual medication options I focused on making adjustments in my life to accomodate the new reality. I'm sort of waking up to the fact that I might be able to do better than this, although it is hard to imagine being as engaged in life as a lot of the people around me. Still, I think back to that course of Nardil... I felt solid and in touch with the best parts of myself. Nothing has ever worked that well before or since. I want that again. Anyway, I see some new medical options, and there are some lifestyle things I can re-embrace that might make a difference.
Regarding Nardil, I never made it as far as a 3 month trial to see if the sexual side effects would dissipate. The weight gain was so pronounced and so rapid (and so not good for my blood pressure) that it was clearly not going to be a suitable long-term therapy. And honestly, 3 months without the big O? How do people do that?
I'm guessing that when the pdoc and I meet, we'll prolly give Cymbalta a go first. Selegiline and parnate also remain options. I also had a pretty good response when I added DHEA and exercise to my moclobemide regimen. I think its worth seeing how restarting DHEA and exercise work out on their own.
By the way, I appreciate your caveats about this message board. I do find this a great place to pick up some new ideas, clarify my own thinking, and benefit from knowing I'm not the only one dealing with this. I take nothing as gospel, though the information people present here is a useful beginning for further investigation.
Best to you in the meantime (fingers still crossed for the success of your Cymbalta trial).
Mark
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