Posted by Ritch on October 9, 2004, at 11:46:34
In reply to Agitation on Cymbalta ... Why?, posted by cache-monkey on October 9, 2004, at 2:16:10
> Hey all,
>
> After a two week trial on Cymbalta I had to discontinue due to severe agitation. (This was on a max dose of 30 mg/day.) My legs were bouncing up and down, my heart rate was up. At first I was sweating like crazy and then I just felt cold all the time. Racing thoughts, couldn't sleep for more than a couple of hours at a time. Basically, I felt like I wanted to crawl out of my skin.
>I got all of that stuff too (at 3mg for about 20 days or so, now at 1mg). I also had transient vertigo(just like I used to get on Prozac). I started checking my BP and HR off and on and found my BP/HR was jumping around and probably had something to do with the vertigo.. it feels a little like postural hypotension from a TCA. The first day I took it a coworker noticed that *only* my right ear was bright red and it felt hot, but the other ear was fine..:) My sleep was disrupted some too, but noradrenergics always do that to me, so I dropped it down and everything has settled down a lot.
> I'm feeling a little better now that I've tapered down and gone off. Although there's been a return of a different kind of anxiety that maybe was lifted by the Cymbalta. I'd rather take this than that crazy agitation right now, but I'm wondering why I had this reaction.
>
The anxiety that was relieved is probably the usual GAD like stuff that a lot of antidepressants work well on. If I completely go off antidepressants that stuff comes back (so I know it is comorbid to my bipolar). But, if I take more than a tiny dose I start getting agitated. That doesn't mean that you have bipolar.. it could just be the same mechanism that causes the restlessness is involved and it could happen to a lot of people.
> I guess I'm trying to figure out if there's anything that can be learned about my specific chemistry and what needs to be balanced. Is it because of the norepinephrine in Cymbalta? An excess of serotonin?The agitation often is just "startup" side effects that do tend to fade with time as your body adjusts to the med. The trick is whether it will actually fade with time or does it seem to get worse. Some folks suggest weeks to find out, it's easier for me just to reduce the dose until I can tolerate it, then consider raising it later on.
>
> I think I also read somewhere that flooding the serotonin system can cause a downregulation of dopamine, which can be implicated in agitation and restlessness. Does anyone know something more definitive about this?I can only speak from personal experiences, but they (SRI's), tend (generally) to make me more apathetic, and I *do* get some mild EPS symptoms similar to antipsychotics that I've taken in the past. I get varying degrees of mild akathisia and dystonia from SRI meds. The different ones express themselves differently with regard to those symptoms. Effexor and now Cymbalta give me a stiff neck (I can put up with that). Zoloft and Prozac- lower back stiffness and occasional ridgity. Paxil/Celexa/Lexapro tended to affect my tongue, throat(tightness) and jaws (clenching-grinding). For some reason Celexa/Lexapro made me want to chew on my lips at times. The more serotonergic they are (selective and potent) the more they tend to get me pacing around a lot (the shuffles). This may have more to do with chronic low-dosing of conventional antipsychotics that I have taken in the past (Thorazine and Mellaril), rather than the SSRI drugs themselves. IOW, I am not a believer (at this time anyhow) that SSRI's cause tardive dyskinesia or tardive dystonia. If I was I wouldn't be on them at all.
>
> Or is it just simply that some people get agitated on some drugs (and not necessarily others in the same class) just based on idiosyncratic factors?I think you have hit the nail on the head.. although you may find that other similar drugs tend to cause the same sort of troubles in that idiosyncratic individual...
>
> Any input would be greatly appreciated.
>
> Thanks,
> cache-monkey
poster:Ritch
thread:400648
URL: http://www.dr-bob.org/babble/20041007/msgs/400715.html