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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by emily elizabeth on November 14, 2012, at 16:37:44
My hubby has been really depressed lately. I think it is sort of a uncomplicated depression (unlike a lot of us here experience) and he hasn't tried many meds so far. He used to take Zoloft, which was okay, but not great. He has some pain issues, so switched to Cymbalta. He says his pain is much better, but I think his depression is much worse (e.g., sleeps ALL weekend, doesn't enjoy anything, irritable). I finally have him seeing a pdoc that I trust on Friday, but I want him to go in prepared with med questions/suggestions. I think he wants to keep the Cymbalta because of the improvement in pain, so I was wondering if something could be added. The only idea I had off of the top of my head was Wellbutrin, but according to the drug interaction checker, they don't mix. It seems a little early to bring out the "big guns" like Abilify. Anyone have ideas?
Thanks!
EE
Posted by jono_in_adelaide on November 14, 2012, at 17:54:11
In reply to Something to add to Cymbalta?, posted by emily elizabeth on November 14, 2012, at 16:37:44
I'd suggest an SSRI (Zolof or Lexapro) combined with Welbutrin 300mg
Posted by Phillipa on November 14, 2012, at 17:58:13
In reply to Something to add to Cymbalta?, posted by emily elizabeth on November 14, 2012, at 16:37:44
EE what type of pain? I found cymbalta really good for pain. And what dose is he on? I know the docs now prescribe for up to 120mg? Phillipa
Posted by emily elizabeth on November 14, 2012, at 18:01:03
In reply to Re: Something to add to Cymbalta?, posted by jono_in_adelaide on November 14, 2012, at 17:54:11
> I'd suggest an SSRI (Zolof or Lexapro) combined with Welbutrin 300mg
Do you think the SSRI would address the pain in the same way that the Cymbalta (SNRI) would? I am not clear on what it is about Cymbalta that makes it good for pain. Do you know?
Thanks,
EE
Posted by emily elizabeth on November 14, 2012, at 18:03:16
In reply to Re: Something to add to Cymbalta? » emily elizabeth, posted by Phillipa on November 14, 2012, at 17:58:13
> EE what type of pain? I found cymbalta really good for pain. And what dose is he on? I know the docs now prescribe for up to 120mg? Phillipa
The pain is a little unclear. It is sort of arthritis-y, but the doc's say he doesn't have arthritis. Lots of aches in his arms and legs. I think he is on 60mg, which I understand is the max dose for mood. I hadn't heard that you could go higher.
Best,
EE
Posted by jono_in_adelaide on November 14, 2012, at 18:56:26
In reply to Re: Something to add to Cymbalta? » jono_in_adelaide, posted by emily elizabeth on November 14, 2012, at 18:01:03
If pain is a concern, go an SSRI such as Zoloft (50-100mg) or Lexapro (10-20mg) plus nortriptyline (75mg-150mg) at bedtime. Start at 75mg, and increase in lots of 25mg untill the sweet spot is reached.
It is a highly effective noradrenalin reuptake inhibitor (better than cymbalta) and is active against pain as well.
This combo is generaly more effective than the SNRI drugs such as Effexor and Cymbalta on depression, and it should still provide good coverage for pain.
He could aslo take a mild NSAID (such as meloxicam, 15mg daily) if he needs an added boost for his pain
Posted by jono_in_adelaide on November 14, 2012, at 18:56:26
In reply to Re: Something to add to Cymbalta? » jono_in_adelaide, posted by emily elizabeth on November 14, 2012, at 18:01:03
If pain is a concern, go an SSRI such as Zoloft (50-100mg) or Lexapro (10-20mg) plus nortriptyline (75mg-150mg) at bedtime. Start at 75mg, and increase in lots of 25mg untill the sweet spot is reached.
It is a highly effective noradrenalin reuptake inhibitor (better than cymbalta) and is active against pain as well.
This combo is generaly more effective than the SNRI drugs such as Effexor and Cymbalta on depression, and it should still provide good coverage for pain.
He could aslo take a mild NSAID (such as meloxicam, 15mg daily) if he needs an added boost for his pain
Posted by emily elizabeth on November 14, 2012, at 19:10:20
In reply to Re: Something to add to Cymbalta?, posted by jono_in_adelaide on November 14, 2012, at 18:56:26
Thanks! Those sound like great ideas. Now to make sure hubby mentions them to the pdoc (another battle entirely!)
Best,
EE
Posted by Phillipa on November 14, 2012, at 21:08:18
In reply to Re: Something to add to Cymbalta? » Phillipa, posted by emily elizabeth on November 14, 2012, at 18:03:16
EE osteoarthristis can begin at any age. Most it seems have it after 40. But knowing you doubt he is this old. Was he an athlete? If so could be. I didn't think a higher dose either til moved here 7 years now and this pdoc here wanted me in 4 weeks total to titrate to 120mg. I said I don't think it's approved in doses this high. He said that works best for him. Needless to say I left this doc. Heard that shortly after he was diagnosed with narocolepsy. He actually fell asleep on an ex-neighbor of mine. So the dose can be raised. I know that my pain is osteoarthritis but when on 60mg of cymbalta no pain and only when came off it did I realize I had back Pain. Not fibromyalgia? If so lyrica is added a lot. Phillipa
Posted by neversaynever on November 15, 2012, at 6:54:11
In reply to Re: Something to add to Cymbalta? » emily elizabeth, posted by Phillipa on November 14, 2012, at 21:08:18
If cymbalta is only helping his pain , then its not the right med , like jono said an ssri like lexapro or zoloft . Then do what i have to do take ibrufin tabs for the pain 3 times a day.
Posted by Emily Elizabeth on November 15, 2012, at 7:12:00
In reply to Re: Something to add to Cymbalta?, posted by neversaynever on November 15, 2012, at 6:54:11
> If cymbalta is only helping his pain , then its not the right med , like jono said an ssri like lexapro or zoloft . Then do what i have to do take ibrufin tabs for the pain 3 times a day.
Sigh. Yes, I agree with that, but it is pretty hard to convince him how poorly it is helping him. I was hoping that there was an easy add on that he could just take. Based on the posts here and my own digging it does seem like going back to the Zoloft and maybe adding a TCA would be a better option. When he was taking the Zoloft he was taking handfuls of advil and Tylenol every day (MD said this was okay) but it wasn't sufficient.
I do suspect that his pain is worsened by his depression and he tends to manifest psychological symptoms physically. I have him seeing a therapist, but he spaces the appts really far apart and then cancels, so he has only been like twice. I am getting frustrated that I care about addressing this more than he does. I wanted to go with him to the pdoc, but he won't let me. Sigh. End rant.
Thanks for your thoughts,
EE
Posted by Emily Elizabeth on November 15, 2012, at 7:20:00
In reply to Re: Something to add to Cymbalta? » emily elizabeth, posted by Phillipa on November 14, 2012, at 21:08:18
> EE osteoarthristis can begin at any age. Most it seems have it after 40. But knowing you doubt he is this old. Was he an athlete? If so could be. I didn't think a higher dose either til moved here 7 years now and this pdoc here wanted me in 4 weeks total to titrate to 120mg. I said I don't think it's approved in doses this high. He said that works best for him. Needless to say I left this doc. Heard that shortly after he was diagnosed with narocolepsy. He actually fell asleep on an ex-neighbor of mine. So the dose can be raised. I know that my pain is osteoarthritis but when on 60mg of cymbalta no pain and only when came off it did I realize I had back Pain. Not fibromyalgia? If so lyrica is added a lot.
He saw a few docs and they say it isn't arthritis. He had some fractures in his knees last year due to low bone density. He's 39 so this was puzzling, but his Vit D was really low, so they treated that. They also found evidence that he previously had Parvovirus (?!) but they couldn't tell him when or if that had any relevance. No one has ever called it fibromyalgia, but I wondered about that too. He's done a little PT but that didn't seem to do much. As I said in the above post, I do think some of his mental distress is expressed physically.
I'm feeling good now, so I want him to feel good too!
Best,
EE
Posted by neversaynever on November 15, 2012, at 9:46:13
In reply to Re: Something to add to Cymbalta? » Phillipa, posted by Emily Elizabeth on November 15, 2012, at 7:20:00
ADs can a do cause jiont pain, its a trade off side effect you either get or you dont. Lots of side effects are has bad has the illness, ie terror nightmares, sexual, constipation, tiredness ,blah feel, ect, ect, the list goes on for ever . Some people take side effects has another faze in the illness an add more meds, only to add more side effects. Your husband needs to get his depression under control an then the pain may not be so server
Posted by rjlockhart37 on November 15, 2012, at 19:24:10
In reply to Re: Something to add to Cymbalta? » jono_in_adelaide, posted by emily elizabeth on November 14, 2012, at 19:10:20
there's some options, if he hasnt been with a doc thats just now starting to treat...i was going to say provigil but that is not going to be used, probaly...
um...there's this stuff called Savella, its used for pain...but its also has antidepressant effects. Also tramadol...but its like playing chess with a doc, you gotta move around with them...sometimes they don't take suggestions because of the ego...
Oh....Lamictal is a great option, i take it, its great for depression nd not a big gun like abilify. Abilify changes the order of thoughts, bot like seroquel, or others but still it can be nasty to someone who is not having mood disorders.
play chess with the doctor, don't obligate, just follow, they should find something.
r
Posted by Phillipa on November 15, 2012, at 20:28:02
In reply to Re: Something to add to Cymbalta?, posted by Emily Elizabeth on November 15, 2012, at 7:12:00
EE typical male. And motrins are not the answer. Pain is a physical manifistation of depression. I know you also know this. Phillipa
Posted by Emily Elizabeth on November 17, 2012, at 19:07:25
In reply to Something to add to Cymbalta?, posted by emily elizabeth on November 14, 2012, at 16:37:44
Hubby saw pdoc yesterday and he decided to do some labs before making any rx changes. I honestly was so frustrated I started crying. The blood tests weren't the standard stuff (thyroid etc.) because they have done those recently and they were fine. This is a fairly new test that looks at levels of neurotransmitters and then he extrapolates the best med based on that. I think he puts too much stock in this test. I have seen this pdoc before (never as my regular pdoc though) and he ran this same test on me. Results suggested serotonin was lower than norepinepherine and dopamine, implying an SSRI would be a good choice. I can tell you with 100% certainty that that would have been a mistake. I have never had a sufficient response to an SSRI and absolutely need a mood stabilizer. I also don't know why he uses this instead of one of the new genetic tests.
The plan is for the pdoc to call with results in 2 weeks and call in an rx change "if necessary". He will see him again in 2 months. You can be damn sure I will be attending the next appt to make sure something happens.
Best,
EE
Posted by Phillipa on November 17, 2012, at 21:19:52
In reply to Frustrated, posted by Emily Elizabeth on November 17, 2012, at 19:07:25
EE does your hubby believe in the test and trust the doctor? As maybe just maybe this will help him become well. And you have more experience don't you with meds. This is a first for him? Phillipa
Posted by Emily Elizabeth on November 17, 2012, at 23:30:54
In reply to Re: Frustrated » Emily Elizabeth, posted by Phillipa on November 17, 2012, at 21:19:52
> EE does your hubby believe in the test and trust the doctor? As maybe just maybe this will help him become well. And you have more experience don't you with meds. This is a first for him? Phillipa
He's been on Zoloft previously and Cymbalta currently and ADHD meds, but never seen a pdoc. I have tried lots of meds myself, have some professional knowledge, and have done some reading on my own. I feel like I could better ask the right questions and better advocate for him. I also suspect that he minimizes some of his symptoms because he doesn't recognize how bad he has gotten. He is happy with the waiting 2 weeks approach and doesn't seem to understand why it upsets me. Men...
Best,
EE
Posted by Phillipa on November 18, 2012, at 0:02:59
In reply to Re: Frustrated » Phillipa, posted by Emily Elizabeth on November 17, 2012, at 23:30:54
EE yes I know and definitely men!!! Let me know how it goes is he able to work? I guess you can't call his doc to to confidentiality. Shame you can't. Phillipa
Posted by Emily Elizabeth on November 27, 2012, at 7:02:52
In reply to Something to add to Cymbalta?, posted by emily elizabeth on November 14, 2012, at 16:37:44
Pdoc called today and said to add Wellbutrin. I found this surprising because every drug interaction checker says that there is a severe interaction with the Cymbalta. Hubby knew this because I had previously told him. He asked pdoc and he said it would be fine. But now he is worried about taking it. I told him to talk to the pharmacist.
Ugh,
EE
Posted by Phillipa on November 27, 2012, at 21:01:52
In reply to Re: Something to add to Cymbalta?, posted by Emily Elizabeth on November 27, 2012, at 7:02:52
EE I didn't know this? Did he talk to pharmacist? Phillipa
Posted by Emily Elizabeth on November 27, 2012, at 21:47:59
In reply to Re: Something to add to Cymbalta? » Emily Elizabeth, posted by Phillipa on November 27, 2012, at 21:01:52
> EE I didn't know this? Did he talk to pharmacist? Phillipa
Pharmacist says it should be fine. There is only a "slight risk" of serotonin syndrome. It makes me wonder about those interaction checkers though. Do they over-react?
Fingers crossed that this works!
EE
Posted by Phillipa on November 27, 2012, at 23:09:50
In reply to Re: Something to add to Cymbalta?, posted by Emily Elizabeth on November 27, 2012, at 21:47:59
EE I know I don't use them anymore & If not the highest doses of the meds it should be fine. I do hope your Husband feels better soon. Phillipa
This is the end of the thread.
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