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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by qbsbrown on January 14, 2006, at 3:28:25
Is this a case of bad marketing? All the ratings i've seen have been quite favorable, especially in comparison to Effexor.
Doesn't the "newest" and "less side effect" drugs just take off, i.e LEXAPRO.
Everyone is told it's the newest, and has the least side effects, so it's the most popular and get high marks (remedyfind.com). Is this placebo effect?Thoughts?
Posted by qbsbrown on January 14, 2006, at 3:37:57
In reply to Why isn't CYMBALTA as popular as one would think?, posted by qbsbrown on January 14, 2006, at 3:28:25
Guess i was wrong.
"Projections are bullish for Lilly's (Research) Cymbalta, which entered the market as an antidepressant in August, 2004, and was also approved in September of that year as a treatment for diabetic peripheral neuropathic pain. The drug's sales during the first nine months of 2005 totaled $451 million. Ryan, the Deutsche Bank analyst, wrote that Cymbalta is off to a "solid launch," and she projected $1 billion in annual sales by 2007. Both Suntrust Robinson Humphrey analyst Hazlett and Bear Stearns' Boris project that Cymbalta could reach $3 billion in annual sales by the end of the decade, bringing it neck in neck with competitor Lexapro."
Posted by blueberry on January 14, 2006, at 6:38:59
In reply to Why isn't CYMBALTA as popular as one would think?, posted by qbsbrown on January 14, 2006, at 3:28:25
I would think cymbalta should be a lot more popular than it is. It may be that it is still considered fairly new by many doctors, mine included, and they tend to stick with what they are familiar with.
On paper at least, there are a lot of positives about cymbalta. For example, its serotonin to norepinephrine ratio is 9 to 1, whereas its competitor effexor is 30 to 1. So there is more norepinephrine action with cymbalta. Plus it has more domamine reuptake inhibition. And all of it comes in linear fashion at any dose, whereas with effexor it requires higher doses to get the norepinephrine or dopamine effects. On paper, cymbalta's side effects and withdrawals are easier than effexor. Cymbalta can be manipulated dramatically with other meds...zyprexa or seroquel or remeron or any antagonistic drug can dramatically enhance either norepinephrine or dopamine or both in the presence of cymbalta, far more than any drug alone. Of course though, how any of this "on paper" stuff translates into the real world is yet to be seen, since it is still fairly new and there isn't a whole lot of experience with it.
I've tried cymbalta several times at miniscule doses...a laughable 1mg to 2mg, and for me I really like it. I am trying other natural things right now, but whenever I really need immediate help, micro doses of cymbalta lift me up dramatically in hours.
Posted by monserrat on January 14, 2006, at 8:01:39
In reply to Re: Why isn't CYMBALTA as popular as one would think?, posted by blueberry on January 14, 2006, at 6:38:59
How many pellets are in 1 mg? Cymbalta at 30 and 60mg didn't do much for me but I've heard talk of microdoses several times on here. Interesting.
> I would think cymbalta should be a lot more popular than it is. It may be that it is still considered fairly new by many doctors, mine included, and they tend to stick with what they are familiar with.
>
> On paper at least, there are a lot of positives about cymbalta. For example, its serotonin to norepinephrine ratio is 9 to 1, whereas its competitor effexor is 30 to 1. So there is more norepinephrine action with cymbalta. Plus it has more domamine reuptake inhibition. And all of it comes in linear fashion at any dose, whereas with effexor it requires higher doses to get the norepinephrine or dopamine effects. On paper, cymbalta's side effects and withdrawals are easier than effexor. Cymbalta can be manipulated dramatically with other meds...zyprexa or seroquel or remeron or any antagonistic drug can dramatically enhance either norepinephrine or dopamine or both in the presence of cymbalta, far more than any drug alone. Of course though, how any of this "on paper" stuff translates into the real world is yet to be seen, since it is still fairly new and there isn't a whole lot of experience with it.
>
> I've tried cymbalta several times at miniscule doses...a laughable 1mg to 2mg, and for me I really like it. I am trying other natural things right now, but whenever I really need immediate help, micro doses of cymbalta lift me up dramatically in hours.
Posted by blueberry on January 14, 2006, at 10:59:36
In reply to Re: Why isn't CYMBALTA as popular as one would think? » blueberry, posted by monserrat on January 14, 2006, at 8:01:39
I think it is something like 10 beads equals 1mg. Probably plus or minus a little bit. I've noticed some of the beads look smaller or larger than others, so even counting them might not be completely accurate. But close enough for me.
One of the inactive ingredients is sugar spheres. Not sure if those look like the beads or if they are incorporated in the medication or what. When dumping out a capsule, most of what is inside is air. So I'm not sure why they would bother putting a filler like sugar spheres in it when there is still so much empty space not filled. If you look real close, you can tell which beads are the real thing. Ones that look too small or not quite right, I don't use those. The vast majority of them look identical.
The beads themselves, not the capsule, are enteric coated to protect the medication inside from stomach acid. So they have to be swallowed with liquid or soft food and not damaged.
I did try 30mg for a couple days and 60mg for one day after that. It was rather numbing, not much effect, just lots of insomnia. For me, more was definitely not better. Somehow the micro dose has a powerful effect where the standard dose doesn't, for me anyway. Can't explain it. And I doubt it would be that way with everyone who tried it.
Posted by Sarah T. on January 14, 2006, at 12:10:27
In reply to Why isn't CYMBALTA as popular as one would think?, posted by qbsbrown on January 14, 2006, at 3:28:25
The first time I asked my doctor about Cymbalta, which was a few months after it had been marketed, he was silent at first, and then he said he wasn't terribly impressed with what he'd seen. I'm not surprised.
I think we'd all be impressed if something truly novel came along, something that works via a different mechanism instead of the same old, same old "me, too" drugs that are all variations on the same theme.
Posted by Racer on January 14, 2006, at 20:47:56
In reply to Re: Why isn't CYMBALTA as popular as one would think?, posted by Sarah T. on January 14, 2006, at 12:10:27
I stayed on Cymbalta for nearly a year and a half, and am not impressed by it. It was always heavily amotivating and sedating for me, although it did help with pain. What it didn't address was depression.
My former doctor, Dr CattleProd, wanted me to stay on it. I think he figured the pain relief was reason enough. Of course, he wasn't the one lying on the sofa all day... I also think he thought I was just "overreacting to a little discomfort," but at this point Quality Of Life counts to me. I didn't have adequate quality of life on Cymbalta, because of the sedation and amotivation.
So, I'm not impresed by it, and I think from reading this board that a lot of other people have had at best mixed responses to it. Who knows what the long term picture looks like for it.
Posted by Phillipa on January 14, 2006, at 21:03:22
In reply to Re: Why isn't CYMBALTA as popular as one would thi, posted by Racer on January 14, 2006, at 20:47:56
Amen l0 days of 30mg cymbalta made my depression worse due to the incredible anxiety I experienced which by way I no where near over. Oh but I also experienced the relief of joint pain. That's how I know it's out of my system as now when I try my feeble attempt at slow jogging l mile my back pain is back. Fondly, Phillipa ps I don't want to jog too depressed!
Posted by Rayray on January 15, 2006, at 13:19:00
In reply to Why isn't CYMBALTA as popular as one would think?, posted by qbsbrown on January 14, 2006, at 3:28:25
I had high hopes for Cymbalta, and went on it shortly after it came out. Unfortunately, for me there was no noticeable advance over Zoloft, plus it had the added effect of raising my blood pressure and making me irritable. These were showstoppers for me. Makes me wonder if others experienced that as well.
When I was coming off it, I noticed a few minor "brain zaps." Must be the NE component because I never had that with a plain SSRI.
Still waiting for the next big thing,
Ray
Posted by Sarah T. on January 15, 2006, at 20:50:48
In reply to Re: Why isn't CYMBALTA as popular as one would think? » monserrat, posted by blueberry on January 14, 2006, at 10:59:36
Hi Blueberry,
When you calculated that 10 beads equals one milligram, was that 10 beads from a 20 mg capsule or 30 mg capsule? I'm wondering whether the 30 mg capsules have more beads or whether the beads in the different strength capsules are actually different.
S.
Posted by Phillipa on January 15, 2006, at 21:26:55
In reply to Re: Why isn't CYMBALTA as popular as one would think? » blueberry, posted by Sarah T. on January 15, 2006, at 20:50:48
Sara, that's a question that has never come up! And what about the 60ng capsules? Fondly, Phillipa
Posted by Sarah T. on January 16, 2006, at 0:58:02
In reply to Re: Why isn't CYMBALTA as popular as one would think? » Sarah T., posted by Phillipa on January 15, 2006, at 21:26:55
Hi Phillippa,
I think that the capsules in different strengths are made up by weight. For example, the 20 mg capsules weigh 20mg regardless of the number of pellets. The 30mg capsules weigh 30mg regardless of the number of pellets. But that still doesn't answer the question of whether each individual pellet is the same whether it's removed from a 20, 30 or 60 mg capsule.
This is the end of the thread.
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