Posted by Racer on September 18, 2004, at 20:41:30
In reply to Re: Emotionally Flat on Paxil - is Lexapro Better?, posted by love bites again on September 18, 2004, at 20:06:30
Cymbalta is brand spanking new. Just approved on 4 August of this year by the FDA. It's a selective serotonin and norepinephrine reuptake inhibitor, so it does a bit more than the SSRIs do, which also means that it's got different side effects. There's another drug with similar effects -- Effexor -- but Cymbalta is supposed to have a more balanced effect on the two neurotransmitters than Effexor, which is a bit skewed towards serotonin at lower doses, with the norepinephrine side kicking in as the dosage goes up. (I can't remember, but it may also affect dopamine at high enough levels.)
There are so many of these drugs out there now that it's often possible to find one that works without causing a lot of grief. It's still trial and error, but having some idea of which side effects are most distressing for you is always helpful -- for example, my blood pressure runs low to begin with, so anything that causes hypotension is probably a bad idea, and I can't handle the weight gain, so that's usually what usually causes me to discontinue a drug. On the other hand, cyproheptidine works well enough for me to counteract the sexual side effects, so that's less of a deal-killer. Knowing those things about yourself will help you work with your doctor to choose a better option for yourself.
As for whether or not one needs to take it forever, that's a hotly debated issue. The consensus I've come across lately says that ADs should be continued for two years for an initial episode of depression, after which they're tapered off. If the depression returns, then five years is recommended, again tapering off. Now, those time frames are starting from the time one reaches full remission, not from when the drug is started.
I, too, have a history of recurrent depressive episodes, and I can tell you that I have gone off anti-depressants after each episode. There's generally a period of a few years before the next episode starts, and for me it's worth being med-free during those times. I do that knowing that it's likely the depression will return, but again -- it's worth it to me. (Then again, I've never been on anything that would be tolerable and effective indefinitely. Either the side effects get to be too much for me, or the med stops working, or both.)
I hope that helps, and best luck.
poster:Racer
thread:392244
URL: http://www.dr-bob.org/babble/20040915/msgs/392433.html