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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Phillipa on January 7, 2006, at 22:15:47
After enduring incredible anxiety, sweating, shaking , inablity to sleep. My pdoc discontinued the cymbalta. They say I am med sensitive. And to wait until the l9 to get the med out of my system and then we'll discuss another med. Is it possible that my chemistry will not allow me to take an AD? I've tried so many and the docs always discontinue them. And truly I'm much better when I stop. No withdrawal. I know you have all been so encouraging and patient when I try these meds. But for what ever reason it seem they don't help but just cause incredible anxiety. Are there any other meds that especially target anxiety and deprssion with anxiety being number l symptom? Thanks, Fonldly, Phillipa
Posted by Glydin on January 7, 2006, at 22:58:20
In reply to No More Cymbalta According to the Pdoc, posted by Phillipa on January 7, 2006, at 22:15:47
This is *NOT* a suggestion, it is merely a question -
How do you think things would go for you if you just used Valium (which you tolerate, correct?) and did not think about trialing a new med or revisiting one you have already tried?
Posted by Phillipa on January 7, 2006, at 23:21:24
In reply to Re: No More Cymbalta According to the Pdoc » Phillipa, posted by Glydin on January 7, 2006, at 22:58:20
Personally I think it's a good idea. Only problem I see is convincing the pdoc. the other only one I do tolerate is luvox. And the funny thing is since this happened I started counting, adding, subtracting in my head. Maybe it's OCD in a simple form. Thanks for not judging me. Fondly, Phillipa
Posted by Sarah T. on January 8, 2006, at 0:03:58
In reply to No More Cymbalta According to the Pdoc, posted by Phillipa on January 7, 2006, at 22:15:47
Hello there, Ms. Phillipa,
I'm sorry you had to go through all that, just to find out that Cymbalta isn't the med for you. If it's any consolation, I have tremendous difficulty with most meds, also. As for drug combinations, forget it! I can't combine anything with anything. A few years ago, when I had Lyme Disease, I had to stop my AD while I was on Doxycycline. I lowered the AD dose and then stopped it. I couldn't find anything in the medical literature about contraindications to combining Doxycycline with the meds I was on, but I got horrendous headaches and several other intolerable side effects. On the Doxycycline alone, I was OK.
May I ask how many milligrams of Cymbalta you were on?
You are not alone, Phillipa. I know it so frustrating, but some day we will find something that helps us. . .
Posted by Emily Elizabeth on January 8, 2006, at 0:07:01
In reply to Re: No More Cymbalta According to the Pdoc » Glydin, posted by Phillipa on January 7, 2006, at 23:21:24
Have you tried the tricyclics lately? I found desipramine to help quite a bit with anxiety (and depression too). I'm sorry that cymbalta was a bust. :(
Best,
EE
Posted by reefer on January 8, 2006, at 8:31:52
In reply to No More Cymbalta According to the Pdoc, posted by Phillipa on January 7, 2006, at 22:15:47
Hi Phillipa! I'm sorry you have been unable to tolerate most AD's. I had a hard time finding one also. Then one doctor suggested checking my metabolism. Genotyping was performed which showed i was a poor metaboliser of CYP2D6 which explains why i had such a hard time finding a med working for me. In my case we found that (es)-citalopram(lexapro) would probably be a good candidate since CYP2D6 had only minor impact on the metabolism of this medicine. And i've been on it ever since. It does it's job for my panic attacks but it's no cure. I still have pretty much anxiety and even though i don't really consider myself as having major depression i'm surely not the happy guy i used to be. That's where the buprenorphine comes in but that is another story(forum thread)...
Anyway my suggestion would be you do genotyping if you haven't already.
Posted by blueberry on January 8, 2006, at 9:08:57
In reply to No More Cymbalta According to the Pdoc, posted by Phillipa on January 7, 2006, at 22:15:47
So sorry Phillipa. I wish I had some good ideas. I sure feel your pain, all the way through this computer.
No matter what is next, I still think it might be good to start at a ridiculously low dose of whatever it is. Cut it in half, cut it in quarters, empty out capsules, whatever.
I've never known anything to stop anxiety for me better than seroquel (takes about an hour), zyprexa (takes about 2 hours), or xanax (takes about half an hour). Depakote did an ok job. Ssri's are a mixed bag, sometimes helping, sometimes worsening, and never being complete...for me anyway.
Posted by ed_uk on January 8, 2006, at 9:38:06
In reply to No More Cymbalta According to the Pdoc, posted by Phillipa on January 7, 2006, at 22:15:47
Dear PJ
What does your new pdoc think of Luvox? Do you think you might try it again - this time gradually increasing to a therapeutic dose?
Ed x
Posted by Phillipa on January 8, 2006, at 12:09:56
In reply to Re: No More Cymbalta According to the Pdoc » Phillipa, posted by ed_uk on January 8, 2006, at 9:38:06
Ed that's what I was kindda hoping. Love PJ O
Posted by Phillipa on January 8, 2006, at 12:13:05
In reply to Re: No More Cymbalta According to the Pdoc » Phillipa, posted by Sarah T. on January 8, 2006, at 0:03:58
Sarah I was on 30mg for only around l0days. Did okay yesterday thought I was getting better. Then last night night terrors began and this morning well ll am I have horrible dizzyness. I quit! fondly, Phillipa
Posted by zero on January 8, 2006, at 21:32:20
In reply to No More Cymbalta According to the Pdoc, posted by Phillipa on January 7, 2006, at 22:15:47
Sorry to hear Cymbalta didn't work out (and for all that distress too!).
You sound like me, in being so meds. sensitive (antidepressant sensitive, specifically).
Any of your doc's ever suggest you might be "soft bipolar", and that a mood stabilizer might be helpful? (Neurontin/Keppra/Depakote help anxiety, Lithium/Lamictal help depression)
Best wishes,
zero
Posted by zero on January 8, 2006, at 21:36:41
In reply to Re: No More Cymbalta According to the Pdoc, posted by reefer on January 8, 2006, at 8:31:52
Where would I find more info. on this "genotyping"?
Was this something a USA doc' had done for you?
Thanks,
zero
Posted by Phillipa on January 8, 2006, at 21:56:12
In reply to Re: No More Cymbalta According to the Pdoc, posted by zero on January 8, 2006, at 21:32:20
I've thought of bipolar also. What about trileptal I took it once at 150mg? What are the symptoms of soft bipolar I always forget and personally I'm too tired to google it? Thanks, Fondly, Phillipa ps I'm becoming afraid to go to sleep with my valium I'm getting such horrible nightmares.
Posted by 4WD on January 8, 2006, at 22:23:17
In reply to Re: No More Cymbalta According to the Pdoc » zero, posted by Phillipa on January 8, 2006, at 21:56:12
Hi Phillipa,
Sorry about your bad experience. I started having anxiety attacks about three weeks into Cymbalta, right after raisig the dosage to 60mg. When I went back down to 30, the anxiety stayed. I stayed on it for 5 months anyway, trying to treat the anxiety with Klonopin and aypicals but nothing worked. I finally gave up. Not that Celexa's any better these days.
I'd like to know about soft bipolar too. Is there a drug to treat the anxiety that doesn't increase the depression (if you have both)?
Marsha
Posted by yxibow on January 8, 2006, at 22:24:52
In reply to Genotyping » reefer, posted by zero on January 8, 2006, at 21:36:41
> Where would I find more info. on this "genotyping"?
>
> Was this something a USA doc' had done for you?
>
> Thanks,
>
> zeroI had mentioned something about this, which I think he is referring to, in
http://www.dr-bob.org/babble/20051231/msgs/596461.html
Here is the FDA letter for Roche's P450 testing system, as an example
http://www.fda.gov/cdrh/pdf4/k042259.pdf
and other results from Googling P450 genotyping
http://www.ashp.org/news/ShowArticle.cfm?id=13597
Its worth noting some more crankier insurance may or may not yet cover this yet, as it is considered novel, but hopefully this will spread and become more commonplace.
Posted by zero on January 8, 2006, at 22:57:30
In reply to Re: No More Cymbalta According to the Pdoc » zero, posted by Phillipa on January 8, 2006, at 21:56:12
For reading about "soft bipolar" I would start here:
http://www.psycheducation.org/index.html
(follow links in the upper left hand corner box, titled "Mood Swings but not 'Manic'").Trileptal might help - its drug relative Tegretol helps me. There are lots of other meds.
zero
Posted by zero on January 8, 2006, at 23:05:31
In reply to Re: Genotyping » zero, posted by yxibow on January 8, 2006, at 22:24:52
Really interesting.
Thank you!z.
Posted by reefer on January 9, 2006, at 18:36:34
In reply to Genotyping » reefer, posted by zero on January 8, 2006, at 21:36:41
> Where would I find more info. on this "genotyping"?
>
> Was this something a USA doc' had done for you?
>
> Thanks,
>
> zeroMy doc just sent me to have a sample of blood taken. This sample was then sent to a lab and they analysed the DNA. They checked CYP 2D6, and CYP 2C19. And it was concluded i was a poor metaboliser of 2D6 and normal of 2C19. This wasn't done in the USA, but in the EU. The test is available in the USA also though. You can find all the info in the world on google. Here is an example search you could use:
http://www.google.se/search?hl=en&q=%2Bgenotyping+%2B2d6+%2B2c19&btnG=Google+Search
Posted by zero on January 9, 2006, at 20:16:52
In reply to Re: Genotyping, posted by reefer on January 9, 2006, at 18:36:34
I was reading about the Roche Amplichip being FDA approved here in the USA. Now trying to find out if my insurance will cover it (though the approx. cost of $250 would be worth it even if I have to pay out of pocket).
I'd really like to have this done. It might lead to a more scientific approach in getting some help for my depression.
I am labeled "Bipolar II/Bipolar NOS", but I suspect many of the "Soft Bipolar" diagnoses such as mine are merely idiosyncratic metabolic responses. The Amplichip and others like it just might shed light on this.
Muchas gracias,
zero
Posted by corafree on January 10, 2006, at 2:00:45
In reply to Re: Genotyping » reefer, posted by zero on January 9, 2006, at 20:16:52
Noticed you're all talking about 'fast metabolization'.
Back a year or so ago, we were talking a lot about Effexor-XR.
I was at a dosage of 225 or something. Anyway, I'd take in a.m., but by about 4-5 p.m., I'd start to feel 'let down; onset of anxiety'.
So, I took one half in the a.m., and before 4 p.m. I'd take the other half. That worked great.
I think that is when I posted about poor metabolizers or fast metabolizers (same thing, I believe). I wrote quite a bit about it here at that time. I could tell my body ate up the one a day dose (Extended release supposed to last a day! Well, not in me, they don't!) in half a day!
For me, Effexor-XR is the only AD that has ever helped to lessen my most severe problem, anxiety.
BUT, I also believe IT CAN TURN ON YOU and kind of work backwards for a stint. Maybe the way it worked once is not the way it will work at another time in your life.
Breakthroughs in pain are your body saying 'Hey, can we have a little extra help .. we're tired'. It's treated w/ your regular med and dosage, and then another booster drug on top of them.
Chronic pain breakthrough lasts 4-5 days more or less. You don't know when it will happen. You could go w/o having any breakthrough pain for months, or on flip side, it could happen three times in one month.
What I am getting at is ... I wonder if this isn't just as possible with 'head drugs'?
Maybe need endocrinology (hormones) lab work done. If hormone levels off, drugs will be off.And nutrition should be taken into consideration.
Am I taking a multi-vite/min and maybe B12 and magnesium? Am I eating enough and am I eating the right kind of food?If the latter two paragraphs are lacking in your physical body, I believe it will effect whether the drug does work as it should or does not.
So, to me, I am seeing that there are a lot of PHYSICAL COMPONENTS that need to be correct in order to 'hold up those psych drugs so they can work right'.
It angers me to see a mental health ward w/o even a vitamin on your morning food tray!
I am personally thinking about Trileptal during the day. Does anyone know of a reason why I could not take an AD for sleep, a mood stabilizer for day, and a benzo for day, the three concurrently?
I've moved and will have a new P soon.
These holidays were awful. Hope everyone o.k.
justtryinbehelpfulhelpsmetoo bestwishes,cf
Posted by Tepiaca on January 10, 2006, at 11:07:34
In reply to Re: No More Cymbalta According to the Pdoc » zero, posted by Phillipa on January 8, 2006, at 21:56:12
Hi Dear Phillipa. Im sorry Cymbalta wasn´t useful
for you. But don´t give up. I believe there is
a med for everyone.
TEPI
Posted by Phillipa on January 10, 2006, at 18:12:17
In reply to Re: No More Cymbalta According to the Pdoc » Phillipa, posted by Tepiaca on January 10, 2006, at 11:07:34
Thanks Tepi, Love phillipa
Posted by Cairo on January 12, 2006, at 20:28:54
In reply to Re: Genotyping » zero, posted by yxibow on January 8, 2006, at 22:24:52
Not to downplay the importance of this genotyping, but if a person has a history of being sensitive to med dosages and side effects, wouldn't the prudent thing to do when adding a new med is to start very low on the dosage and go slow on the increase? I guessed years ago that I might be a slow metabolizer for 2D6 because of my side effect profile and I feel that I don't need to spend money on the genotyping at this point in time.
If one was totally med (free) "virgin" and needed a therapeutic dosage for a dire situation needing quick response, genotyping would be useful, but many of us on this forum can make some intelligent suppositions based on our history, I think.
I'm more interested in seeing studies on combining various meds at lower doses to decrease side effects or sub-typing depressions, anxiety disorders.
Cairo
> I had mentioned something about this, which I think he is referring to, in
>
> http://www.dr-bob.org/babble/20051231/msgs/596461.html
>
> Here is the FDA letter for Roche's P450 testing system, as an example
>
> http://www.fda.gov/cdrh/pdf4/k042259.pdf
>
> and other results from Googling P450 genotyping
>
> http://www.ashp.org/news/ShowArticle.cfm?id=13597
>
>
> Its worth noting some more crankier insurance may or may not yet cover this yet, as it is considered novel, but hopefully this will spread and become more commonplace.
>
>
>
>
>
Posted by Cairo on January 13, 2006, at 21:33:38
In reply to Re: No More Cymbalta According to the Pdoc, posted by reefer on January 8, 2006, at 8:31:52
http://www.clinicalpsychiatrynews.com/article/PIIS0270664405706007/fulltext
Cairo
Posted by yxibow on January 14, 2006, at 0:06:43
In reply to Re: Ethnicity and Drug Metabolism Article, posted by Cairo on January 13, 2006, at 21:33:38
> http://www.clinicalpsychiatrynews.com/article/PIIS0270664405706007/fulltext
>
> CairoYes, these differences are well known and important and all the more reason for genetic testing. Its controversial of course to say that there are differences in race but we're talking on the microscopic level of one gene or allele that affects things. This doesn't even have to be psychiatric drugs -- certain food and beverage allergies are prevalent among certain populations in the world.
This is the end of the thread.
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