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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by dmlvt on August 12, 2008, at 14:53:08
I have been trying to find a way around sexual side effects of Cymbalta. I take a small dose of Cymbalta (20mg) daily, plus 150mg of Wellbutrin.
We tried doubling the WB and tapering off the Cymbalta, but my brain was clearly unhappy with that approach. My PCP has now prescribed Asendin (Amoxopine) instead of the Cymbalta.
From what I've read of this drug, I have to admit that I'm almost afraid to start taking it. I don't understand the "why" of an old-school TCA and I'm also afraid of gaining weight on it. Lastly, I'm an athlete and I really worry about its impact on athletic endeavors. Stories of EPS, TK, etc. sound pretty scary to me.
Damon
Posted by Phillipa on August 12, 2008, at 18:38:54
In reply to Asendin to replace Cymbalta?, posted by dmlvt on August 12, 2008, at 14:53:08
What scares me more about the TCA's is the heart arrythmias they can cause as heart attacks in my family history. Many times I've google them. Phillipa
Posted by SLS on August 12, 2008, at 20:13:03
In reply to Asendin to replace Cymbalta?, posted by dmlvt on August 12, 2008, at 14:53:08
Amoxapine (Asendin) seems like a strange TCA to try first. It is a derivative of Loxapine, an old antipsychotic, and has been known to produce EPS.
I think it is worth trying at least one TCA. The two that have the mildest anticholinergic side effects are nortriptyline and desipramine. A drug that produces a high anticholinergic load can reduce the contractility of muscles. You won't be as strong or capable of completing as many repetitions as you are now. The differences are not dramatic, though.
There was some thought years ago that Asendin worked faster than the other TCAs. However, unless you have a psychotic depression, I don't think Asendin is the best match.
- Scott
Posted by Phillipa on August 12, 2008, at 20:46:29
In reply to Re: Asendin to replace Cymbalta? » dmlvt, posted by SLS on August 12, 2008, at 20:13:03
Still would love to know what TCA was given to me called by the pdoc an upper/downer when had the first panic attack was up all night walking the streets crying it was the most horrible experince. Phillipa
Posted by SLS on August 13, 2008, at 5:18:53
In reply to Re: Asendin to replace Cymbalta? » SLS, posted by Phillipa on August 12, 2008, at 20:46:29
> Still would love to know what TCA was given to me called by the pdoc an upper/downer when had the first panic attack was up all night walking the streets crying it was the most horrible experince. Phillipa
With experiences like that in your treatment history, it is no wonder that you are so shy to try new medications.
- Scott
Posted by dmlvt on August 13, 2008, at 8:37:10
In reply to Re: Asendin to replace Cymbalta? » dmlvt, posted by SLS on August 12, 2008, at 20:13:03
I seem to have forgotten how to use these boards. My moods have been so stable that I haven't been here much in the past couple years, and my last attempt to post didn't work.
Anyway, my doctor picked amoxapine for a couple reasons. First was the similarity to Cymbalta in terms of neurotransmitters affected, although dopamine is affected in a different manner than with Cymbalta. Secondly, he has had success with it in at least one other patient for treating sexual side effects of either an SSRI or SNRI - he didn't say which.
He intends to keep the dose low, probably 2x50mg, because a low dose of Cymbalta was enough for me, when augmented with Wellbutrin.
But, as someone who competes in long distance races, lifts weights regularly, and also gains weight easily, I remain pretty much afraid to try this medication.
I don't know what alternative I'd suggest for getting rid of the sexual side effects of Cymbalta, but this option worries me. It seems like there must be better options. Any thoughts on other things I could suggest to my doc?
Thanks for the responses.
dml
Posted by SLS on August 13, 2008, at 8:56:42
In reply to Re: Asendin to replace Cymbalta?, posted by dmlvt on August 13, 2008, at 8:37:10
I would ask your doctor why he chose amoxapine. For me, it lowered my libido substantially.
How does Cymbalta affect dopamine?
- Scott
Posted by dmlvt on August 13, 2008, at 9:12:17
In reply to Re: Asendin to replace Cymbalta? » dmlvt, posted by SLS on August 13, 2008, at 8:56:42
I think my doctor may have mistyped in his message to me. I think the dopamine effect he is referring to is probably from the Wellbutrin I take, not from Cymbalta. I wrote my last message based on his, but I think he had made a mistake.
I think he chose it based on a sample of one - a single woman who saw sexual side effects disappear when using it, plus the fact that TCAs do act in the same areas as Cymbalta.
I'm a guy though, so I'm not sure why I should see the same effects that a female patient saw.
I remain skeptical and may have to talk to the doc some more. Or perhaps, I should return to my p-doc rather than my PCP for help in this area. I transferred my care to my PCP two years ago, after things really seemed stable from a mental perspective.
I have endured these side effects for years, thinking that my mental health and my ability to be a good husband and father was more important than the inconvenience to me. Now that I've been relatively stable for 3 years and completely stable for 2, I wanted to go after the one lingering problem I've had with these meds.
The first attempted change - drop Cymbalta and double Wellbutrin was my idea. Even with a slow taper from Cymbalta, I could feel myself becoming depressed again. So, this was the doctor's next suggestion.
Again, thank you for the responses. It's been a while since I've been here and it's nice to know that there are still people out here willing to help others.
dml
Posted by med_empowered on August 13, 2008, at 10:22:22
In reply to Re: Asendin to replace Cymbalta?, posted by dmlvt on August 13, 2008, at 9:12:17
personally I'd be afraid of Asendin, unless you have some sort of psychosis going on. It can cause EPS and tardive dyskinesia, which isn't a problem you'll find with most more modern antidepressants (although apparently long-term TCA use can cause TD in some vulnerable patients, even when the TCA isn't amoxapine or triavil).
Have you tried adding in a low-dose atypical antipsychotic? I would think (as a layperson) that adding in, say, low dose Abilify, might do some things that Asendin would do, but with fewer side effects (although it could be considerably more expensive).
Posted by dmlvt on August 13, 2008, at 14:07:49
In reply to Re: Asendin to replace Cymbalta?, posted by med_empowered on August 13, 2008, at 10:22:22
I hadn't seen him in quite a while, because there'd been no need. His answer was brief and to the point: "Not amoxapine!"
He asked me to make an appointment to come and see him rather than relying on my PCP for any med changes.
I have already made that appointment.
dml
Posted by Phillipa on August 13, 2008, at 20:46:59
In reply to Re: Asendin to replace Cymbalta? » Phillipa, posted by SLS on August 13, 2008, at 5:18:53
Scott finally someone understands thanks. Phillipa
Posted by dmlvt on September 29, 2008, at 15:07:37
In reply to Re: Asendin to replace Cymbalta? » SLS, posted by Phillipa on August 13, 2008, at 20:46:59
After weeks of back and forth on this issue, my PCP and PDOC ended up discussing Periactin and Viagra as options to treat the sexual side effects from Cymbalta. We tried some "drug holidays", with no noted benefit.
Right now, we're trying Viagra to see how it works.
The Pdoc definitely didn't want me on Asendin (sp.?)
DML
Posted by manic666 on October 2, 2008, at 13:10:50
In reply to Re: Asendin to replace Cymbalta?, posted by dmlvt on September 29, 2008, at 15:07:37
mmmmmmmmmmmmmmmmm cybalta im supposed to be on 60mg but went down on my own to 40 mg. now 10 inch of the 12 is workin . just kiddin, but since on the 40mg the magic wand is 90%an i have no trouble firing the little white mice. sure i still take 4.loz a day but they do nothing now but without them i crash an burn. on the 40mg of cym the depression is waiting in the wings. but he is always not far away. its a chance i take for my wife,she is the one to look to me when he returns . mannic666
Posted by Lamdage22 on June 10, 2016, at 10:57:38
In reply to Re: Asendin to replace Cymbalta? » dmlvt, posted by SLS on August 13, 2008, at 8:56:42
> I would ask your doctor why he chose amoxapine. For me, it lowered my libido substantially.
Scott, i know this is almost 10 years old, but let me ask: I wouldnt mind less libido at all. However anorgasmia or erectile dysfunction i try to avoid.
I am having sexual trouble with Luvox at 50mg.
Posted by SLS on June 10, 2016, at 16:08:05
In reply to @Scott: Asendin and sexual side effects, posted by Lamdage22 on June 10, 2016, at 10:57:38
> > I would ask your doctor why he chose amoxapine. For me, it lowered my libido substantially.
>
> Scott, i know this is almost 10 years old, but let me ask: I wouldnt mind less libido at all. However anorgasmia or erectile dysfunction i try to avoid.
>
> I am having sexual trouble with Luvox at 50mg.That sucks. Sorry to hear that.
I remember having a mild loss of libido, but not erectile dysfunction or anorgasmia. Everyone is different, though, of course. See if you can find anything on the Net about loxapine and sexual side effects. If loxapine has some liability, then I guess amoxapine would, too. Amoxapine is a derivative of loxapine.
- Scott
This is the end of the thread.
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