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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by greywolf on September 26, 2006, at 4:27:53
Many of you have heard this before. I'm BPII, and after trying every AD you can think of, including MAOIs, and running through ineffectual courses of lithium, depakote, and lamictal, my psydoc now says that he doesn't think there's any med targeted to BP that will help me.
He now wants to try going back to treating just the depression, and has started me on Cymbalta 30mg/day for 1 week, then 60mg/day thereafter. He suggests that Cymbalta has fewer side effects than many of the reuptake inhibitors. We'll see. My biggest problem with all of them is fatigue, and I have read that that's common with Cymbalta.
But what I'm really worried about is this: I have a really severe OCD problem that I have been seeing a therapy specialist for. The plan was to treat the OCD less aggressively than the BP, and once we had a handle on the BP, then add in some meds for the OCD. But we're making no progress on the BP, and the OCD is honestly ruining my life. Every waking moment is filled with OCD problems and the stress is just out of sight. I've got Xanax to help, but I can't take it very often because it interferes with my work.
I don't know what to do.
Greywolf
Posted by Racer on September 26, 2006, at 12:09:18
In reply to Everything else failed, now it's Cymbalta's turn, posted by greywolf on September 26, 2006, at 4:27:53
Well, good news/bad news...
Cymbalta did have fewer side effects for me. Far fewer, in fact, than any other med I've tried, except Wellbutrin. That's the good news.
Fatigue? Uh... I didn't have fatigue, per se, but I was so entirely unmotivated that standing up seemed pretty ambitious. Again, it wasn't fatigue, not at all. It was something different, but the result was the same.
As for OCD, yeah, I'd say it makes sense to treat that more aggressively. If you don't get manic/hypomanic regularly, the OCD is likely to cause more impairment. Cymbalta might be a good choice for that, by the way.
I know I haven't told you much, but I hope the little bit here helps.
Posted by greywolf on September 26, 2006, at 14:44:33
In reply to Re: Everything else failed, now it's Cymbalta's tu, posted by Racer on September 26, 2006, at 12:09:18
Thanks, Racer. Anything helps.
My frustration level after years of this is at an all-time high. Frankly, I'd take my idiocy during the manic times anyday over this depression and the side effects caused by the ADs. I wish my docs would just give me a stimulant to offset the AD SEs, but they're concerned about making the manic aspect worse. I understand that they have a job to do, but I'd rather be going 110 mph than 5 mph in reverse.
Thanks again.
> Well, good news/bad news...
>
> Cymbalta did have fewer side effects for me. Far fewer, in fact, than any other med I've tried, except Wellbutrin. That's the good news.
>
> Fatigue? Uh... I didn't have fatigue, per se, but I was so entirely unmotivated that standing up seemed pretty ambitious. Again, it wasn't fatigue, not at all. It was something different, but the result was the same.
>
> As for OCD, yeah, I'd say it makes sense to treat that more aggressively. If you don't get manic/hypomanic regularly, the OCD is likely to cause more impairment. Cymbalta might be a good choice for that, by the way.
>
> I know I haven't told you much, but I hope the little bit here helps.
Posted by yxibow on September 26, 2006, at 16:55:53
In reply to Everything else failed, now it's Cymbalta's turn, posted by greywolf on September 26, 2006, at 4:27:53
> Many of you have heard this before. I'm BPII, and after trying every AD you can think of, including MAOIs, and running through ineffectual courses of lithium, depakote, and lamictal, my psydoc now says that he doesn't think there's any med targeted to BP that will help me.
>
> He now wants to try going back to treating just the depression, and has started me on Cymbalta 30mg/day for 1 week, then 60mg/day thereafter. He suggests that Cymbalta has fewer side effects than many of the reuptake inhibitors. We'll see. My biggest problem with all of them is fatigue, and I have read that that's common with Cymbalta.
>
> But what I'm really worried about is this: I have a really severe OCD problem that I have been seeing a therapy specialist for. The plan was to treat the OCD less aggressively than the BP, and once we had a handle on the BP, then add in some meds for the OCD. But we're making no progress on the BP, and the OCD is honestly ruining my life. Every waking moment is filled with OCD problems and the stress is just out of sight. I've got Xanax to help, but I can't take it very often because it interferes with my work.
>
> I don't know what to do.
>
> GreywolfCymbalta for me has significantly improved my depression (with breakthrough moments nonetheless) and much less harsh than Effexor (which I could never stand). Nonetheless it doesnt, for me, stop racing mind garbage OCD thoughts completely. They're not terribly intrusive, so I imagine you've got a much tougher case, but Luvox was rather effective against OCD in the past. Anafranil is too (not that I've tried it.)
Posted by Jost on September 26, 2006, at 19:37:28
In reply to Re: Everything else failed, now it's Cymbalta's tu, posted by greywolf on September 26, 2006, at 14:44:33
How about provigil? Would that be a problem? It's much less, or even not, addictive.
Also I didn't have fatigue from cymbalta, except to the extent that it somewhat affected my sleep. But I'm highly sensitive to anything that affects serotonin too much, so I had to stick to a very low dose. A higher dose would clearly have been more effective to me. I really would have liked to go up a lot.
The SE profile has been to different for everyone, so try not to assume the worst-- if only to avoid a nocebo effect at the beginning...
Jost
Posted by Phillipa on September 26, 2006, at 22:33:06
In reply to Re: Everything else failed, now it's Cymbalta's tu » greywolf, posted by Jost on September 26, 2006, at 19:37:28
Serotonin hypes me except luvox and I'm now going up on it I think it does help OCD. love Phillipa
Posted by greywolf on September 26, 2006, at 23:18:51
In reply to Re: Everything else failed, now it's Cymbalta's tu, posted by Phillipa on September 26, 2006, at 22:33:06
I think you are all right insofar as making sure I give it a fair shot. But it's just become so damn hard to go back to the ADs again. I've been on them all--serzone, luvox, paxil, prozac, wellbutrin, effexor, clomipramine, imipramine, lexapro, nardil, trazodone, remeron, zoloft, yada yada yada. It's been years of crappy SEs with little or no therapeutic benefit, or courses with meds like wellbutrin, nardil, depakote, and lamictal where I tolerated them well, but they had no significant effect regardless of the dosage. Nardil worked fine for a short while, but ultimately there was really no effect.
But now, the OCD is really starting to run my life, to the point where I now spend hours of my day in checking, counting, or repetitive behaviors, and I spend a ton of concentration and energy trying to camouflage those behaviors.
I'm lucky because I have a wonderful therapist who is widely recognized for her work with OCD. I accept that it's a slow process, but I was so hopeful that the work I've been doing could be augmented with some med help. I just don't think Cymbalta will cut it.
Posted by yxibow on September 27, 2006, at 0:19:10
In reply to Re: Everything else failed, now it's Cymbalta's tu, posted by greywolf on September 26, 2006, at 23:18:51
> I think you are all right insofar as making sure I give it a fair shot. But it's just become so damn hard to go back to the ADs again. I've been on them all--serzone, luvox, paxil, prozac, wellbutrin, effexor, clomipramine, imipramine, lexapro, nardil, trazodone, remeron, zoloft, yada yada yada. It's been years of crappy SEs with little or no therapeutic benefit, or courses with meds like wellbutrin, nardil, depakote, and lamictal where I tolerated them well, but they had no significant effect regardless of the dosage. Nardil worked fine for a short while, but ultimately there was really no effect.
>
> But now, the OCD is really starting to run my life, to the point where I now spend hours of my day in checking, counting, or repetitive behaviors, and I spend a ton of concentration and energy trying to camouflage those behaviors.
>
> I'm lucky because I have a wonderful therapist who is widely recognized for her work with OCD. I accept that it's a slow process, but I was so hopeful that the work I've been doing could be augmented with some med help. I just don't think Cymbalta will cut it.
>Did you try Luvox at 450 or Anafranil beyond PDR doses augmented with Seroquel or Zyprexa ? Sometimes tough OCD cases need neuroleptic augmentation. Just a thought.
But the biggest thing besides medication, namely the above, perhaps with klonopin too, is CBT therapy.
Posted by Lindenblüte on September 28, 2006, at 15:40:12
In reply to Re: Everything else failed, now it's Cymbalta's tu » greywolf, posted by yxibow on September 27, 2006, at 0:19:10
I took cymbalta 30 mg for a week, then 60 mg for 5 weeks, then 90 mg for the last 3 months. My depression has improved significantly. Fatigue went away after a few days on the 30 and 60 mg doses, but on 90 mg, I have significant daytime fatigue. I have tried taking it at night and in the am. I take it at night, which lets me sleep through the worst of the side effects (occasional stomach upset and some heart thumping/leg twitching kind of activating effects from time to time). Still- I was taking naps for about 4-6 hours during the daytime, and groggy the rest of the time. Provigil is a life saver. 200 mg of that is keeping me awake during the day, and helping me get my work (um.. babble?) done.
I have a lot of intrusive thoughts related to anxiety (also suicidal thoughts when I was really depressed). I have found that seroquel helps with the intrusive thoughts that wake me up and keep me awake in the wee hours of the am. Also seems to calm them down during the day. Recently, however, I am having a lot of intrusive thoughts of the post-traumatic variety, and so we increased my pm dose of seroquel from 25 to 50 mg. Still not quite doing the trick though. I'm unsatisfied.
Pdoc keeps telling me that cymbalta will work against anxiety. maybe after a LONG time you might get a subtle effect, but in the short run, you may get heart palpitations and an increase in muscle tension that is not likely to leave you feeling "relaxed".
It's been a very good AD for me though.
good luck greywolf (crossing my fingers for you)
-Li
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