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Dr. Bob is Robert Hsiung, MD,
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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
Posted by yznhymer on September 15, 2004, at 11:05:30
In reply to Re: Cymbalta (duloxetine) - report » yznhymer, posted by iris2 on September 15, 2004, at 10:11:57
> 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.
>
> ireneNo way to know for sure, but I suspect the DHEA because it kicks up testosterone and because the acne abated when I stopped taking it even though I continued on the moclobemide. I need to reread that link I sent you myself. I'm curious to know how much DHEA they used in the trials and what they considered a therapeutic dose. BTW, DHEA is pretty cheap at COSTCO. I'm also convinced exercise is an important adjunct to maintain mental health. But how do you get a depressed person to exercise?
Posted by Dr. Bob on September 15, 2004, at 18:39:04
In reply to Re: Cymbalta (duloxetine) - report » yznhymer, posted by iris2 on September 15, 2004, at 8:20:18
> I am curious about the DHEA? ...
Sorry to interrupt, but I'd like to redirect follow-ups regarding DHEA to Psycho-Babble Alternative. Here's a link:
http://www.dr-bob.org/babble/alter/20040901/msgs/391210.html
Thanks,
Bob
Posted by Dr. Bob on September 15, 2004, at 18:42:16
In reply to Re: Cymbalta (duloxetine) - report » iris2, posted by yznhymer on September 15, 2004, at 11:05:30
> But how do you get a depressed person to exercise?
Sorry to interrupt again, but I'd also like to redirect follow-ups regarding exercise to Psycho-Babble Health. Here's a link:
http://www.dr-bob.org/babble/health/20040729/msgs/391214.html
Thanks,
Bob
Posted by iris2 on September 15, 2004, at 19:07:10
In reply to Redirect: DHEA, posted by Dr. Bob on September 15, 2004, at 18:39:04
Posted by SLS on September 16, 2004, at 8:40:16
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 13, 2004, at 7:26:04
9/16/2004
Day 28
6 days at 30mg
22 days at 60mg60mg (30mg b.i.d.)
I am sure that I have begun to see some improvement again. My mood is a bit brighter and I have somewhat more energy. There is no appreciable improvement in my ability to read and concentrate yet. There is no significant increase in motivation nor improvement in anhedonia, although these things are generally more latent than energy in appearing.
The only side effect that I might be experiencing is a decrease in libido. Again, it is difficult to parse it from the loss of libido that depression causes me, but I am hopeful that it will return as the depression remits.
I remain hopeful.
- Scott
Posted by ravenstorm on September 16, 2004, at 9:32:22
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 16, 2004, at 8:40:16
Posted by flipsactown on September 16, 2004, at 11:27:23
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 16, 2004, at 8:40:16
Posted by Paul_d_234 on September 16, 2004, at 15:32:34
In reply to Re: Cymbalta Improvement Slowly, but Surely! (nm), posted by flipsactown on September 16, 2004, at 11:27:23
Posted by karaS on September 16, 2004, at 18:04:35
In reply to Re: Scott, glad to hear its starting to help again (nm), posted by Paul_d_234 on September 16, 2004, at 15:32:34
Posted by sunshine211 on September 18, 2004, at 9:50:32
In reply to Cymbalta (duloxetine) - report, posted by SLS on August 21, 2004, at 8:13:25
I have gone through most of the posts about Cymbalta. As a newbie, I must apologize that I do not know everyone's backround.
Those that are taking Cymbalta, why?
I have a dx of PTSD/major depression/anxiety.I have been taking Paxil for 6 months now, I feel way better than I did, but recently had a trigger for the PTSD, crasy nightmares are back when I actually do sleep (insomnia). SO my pdoc wanted to switch. I think it sounds good.
-Scott- I saw your page with the med list! amazing.
I noticed that the difference between paxil and cymbalta is their dx associations. no Ptsd etc. like the paxil.
Anybody have any imput from a similar diagnosis?
:)
Posted by Paul_d_234 on September 18, 2004, at 11:33:08
In reply to Re: Cymbalta-PTSD/depression, posted by sunshine211 on September 18, 2004, at 9:50:32
I have depression and anxiety. When my depression is under control I have no anxiety and vis versus.
Posted by Paul_d_234 on September 18, 2004, at 11:36:16
In reply to Re: Cymbalta-PTSD/depression, posted by sunshine211 on September 18, 2004, at 9:50:32
I have depression and anxiety. When my depression is under control I have no anxiety and vis versus.
Posted by SLS on September 19, 2004, at 7:11:03
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 16, 2004, at 8:40:16
9/19/2004
Day 31
6 days at 30mg
25 days at 60mg60mg (30mg b.i.d.)
I am still experiencing a subtle improvement. This is a good thing. However, I wish it were more robust so that I could have more confidence that things were really headed towards remission. Hopefully, this will be the case over these next few weeks. Still, it is frustrating.
For me, Cymbalta is still a pretty clean drug. However, my sex drive has definitely been decreased by it. It reminds me of Zoloft in this regard.
Still hopeful...
- Scott
Posted by theo on September 19, 2004, at 7:58:15
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 19, 2004, at 7:11:03
Hey Scott,
Have you thought about trying 60mg in the morning versus 30mg BID to see if a stronger initial dose feels any better?
Also, I added a small dose (10mg) Prozac to my 100mg Lamictal and 750mg Keppra mainly because she's (my pdoc) never prescribed it to me and wanted me to try it before Cymbalta.
I'm experiencing the same results from Prozac that I knew I would since I've been on and off of it several times: relief from depression but "zombie like" and drive/motivation (follow through in tasks) worse. Also, nothing for social anxiety because Prozac has zero calming effect like Paxil, which I won't try again because complete sexual dysfuntion including erectile.
With your 31 days on Cymbalta, even though it may be a completely different feeling than the other meds, do you think it could be better than Prozac for the social anxiety and drive/motivation problems? Also, do you have the zombie effect with Cymbalta that many SSRI's can cause, (happy and smiling but not wanting to follow through with anything)?
I went for my yearly physical exam with my regular doc and was discussing with him my current meds and my problems with Prozac. He suggested Cymbalta because he said it can be calming because of something to do with "calming nerve endings" and went way over my head with medical lingo on his explaination.
My pdoc appointment is this Thursday 9/23/04 and any input would be appreciated.
Posted by Minnie-Haha on September 19, 2004, at 9:09:23
In reply to Re: Cymbalta-PTSD/depression » sunshine211, posted by Paul_d_234 on September 18, 2004, at 11:33:08
> I have depression and anxiety. When my depression is under control I have no anxiety and vis versus.
Sounds just like me (plus insomnia, which is worse when anxiety is up, of course).
Are you one of the ones here trying Cymbalta? If not, what are you taking? And in either case, what's working?
Posted by SLS on September 19, 2004, at 9:30:48
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by theo on September 19, 2004, at 7:58:15
Hi Theo.
> Have you thought about trying 60mg in the morning versus 30mg BID to see if a stronger initial dose feels any better?
That's a good idea. I think I'll give it a try in a few days if I feel I've become stuck.
> Also, I added a small dose (10mg) Prozac to my 100mg Lamictal and 750mg
What happens when you raise the dosage of Lamictal to 200mg?
> Keppra mainly because she's (my pdoc) never prescribed it to me and wanted me to try it before Cymbalta.
My doctor feels that Keppra can actually have a destabilizing effect on some people. I know Dr. Ivan Goldberg is not terribly impressed with it for bipolar disorder. I don't know about how he feels about its use for anxiety, but I don't think he uses it much.
> With your 31 days on Cymbalta, even though it may be a completely different feeling than the other meds, do you think it could be better than Prozac for the social anxiety and drive/motivation problems?
I'm sure you've read that a few people here have noted an immediate decrease in their anxiety, but I don't know if anyone had been suffering from social anxiety specifically. Yes, I do feel that Cymbalta has the potential to be better than Prozac for SA, and might offer advantages to Effexor in that regard.
> Also, do you have the zombie effect with Cymbalta that many SSRI's can cause,
No, and that's one of the advantages I feel Cymbalta would have over Effexor.
> (happy and smiling but not wanting to follow through with anything)?
I am guessing that Cymbalta will produce amotivation in some people. I can't say that I have experienced this yet. One person is reporting it, however. Like other antidepressants, there will be great differences in how each individual reacts to Cymbalta, although I think certain trends are beginning to make themselves visible in the reports offered by the people who are posting. It is just too early to be so definite in predicting how any one person will react to it.
It looks like Cymbalta will be a good drug to treat anxiety disorders as well as depression.
- Scott
Posted by iris2 on September 19, 2004, at 10:00:42
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 19, 2004, at 7:11:03
Scott,
I've been meaning to tell you how great I think it is taht you are giving this a good trial. You have patience. I hope it works out for you. You deserve it.
irene
Posted by iris2 on September 19, 2004, at 10:06:57
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 19, 2004, at 9:30:48
I saw you mentioned this doctors name. I had called his office for an appointment once and left a message. I have had difficulty finding a new pdoc in Pittsburgh. What do you think of going to him as my pdoc? I have not inquired as to the cost yet. Do you have any idea?
irene
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