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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by keeppluggin on January 2, 2006, at 9:38:20
I have been taking 60 mg of Cymbalta for one year with moderate gains and am considering switching to Effexor (which as worked extremely well for a sibling). What would an equivalent dosage be?
Posted by Racer on January 2, 2006, at 12:32:57
In reply to Dosing: Cybalta versus Effexor, posted by keeppluggin on January 2, 2006, at 9:38:20
60mg Cymbalta, as I'm sure you know, is the Standard Dose which the company says gives optimal results for everyone. Effexor has a much, much wider dosing range, so there's no standard 'this works best for most' dose.
In my own experience, though, Effexor was a bit more effective than Cymbalta, but it conked out on me after about a year and a half. I was taking 225mg of the Effexor XR, with a small dose of Prozac, as well. I took 60mg of Cymbalta, but it left me lethargic and miserable about that. I went down to 40mg, then 20mg, but finally just stopped it. The only thing it was doing for me in teh end was just wiping me out.
Effexor's effects, though, will be different at different dosages -- at lower doses, under about 150mg, it targets mostly serotonin. Above that, it starts to hit norepinephrine. You'll have to experiment a bit to find what works best for you.
Good luck.
Posted by Phillipa on January 2, 2006, at 18:44:53
In reply to 'Tain't that easy, I'm afraid, posted by Racer on January 2, 2006, at 12:32:57
Hey that's interesting Racer. And I've found the docs now like cymbalta better. Do you know why? Fondly, Phillipa
Posted by med_empowered on January 2, 2006, at 19:30:56
In reply to Re: 'Tain't that easy, I'm afraid » Racer, posted by Phillipa on January 2, 2006, at 18:44:53
I think docs like Cymbalta more b/c 1) its newer, which is always nice and 2) the dosing schedule makes it really easy to use, especially in Primary Care (GPs write 70% of all psychotropic RXs in the US). Cymbalta is an equipotent reuptake inhibitor of norepinephrine and serotonin; Effexor starts out hitting only serotonin, then hits norepinephrine, and then hits a bit of dopamine, too.
Originally, Effexor was designed to go anywhere from 75mgs/day to 375mgs/day...now, some people go up to about 600mgs/day.
If Cymbalta is working somewhat, you could try upping the dose (I took 90mgs, some people take up to 120mgs) and/or augmenting. If you need more stimulation, I would think adding something like Wellbutrin, maybe Pamelor, would be helpful; Provigil might also be good, but its awfully expensive. If you're having sexual side effects or anxiety, add-on BuSpar might help (and boost the AD effects, as well). Some combos have their own names now, like "California Rocket Fuel"--Effexor, Remeron (you could just pop on 30+mgs Remeron to your Cymbalta and see how that goes..it'd be a similar combo). If newer meds fail, you could add some old-school stuff--benzos, amphetamines, that kind of thing. Atypical antipsychotics are also an option, but I think those should be used more sparingly than they are being used now.
I hope everything works out for you. Good luck!
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