Posted by med_empowered on September 22, 2005, at 18:46:40
In reply to Re: Cymbalta Does Not Seem To Work Compared To Effexor, posted by blondemomints on September 22, 2005, at 10:14:30
hey! The standard dose of cymbalta is 60mgs for *everyone*...that covers diabetic neuropathic pain and major depressive disorder. Based of Eli Lilly's data, less than 60mgs doesn't give a reliable antidepressant effect, and more than 60mgs doesn't offer any additional benefit for either depression or neuropathic pain (any possible benefits are largely offset by an increase in side-effets). Cymbalta is stronger than effexor in terms of reuptake inhibition, so its kind of like a Tricyclic with a bit more serotonin action and a different side effect profile, one that is more in line with SSRIs. I took 90mgs b/c my shrink claimed it would help with ADD symptoms. *BAD CALL*. I felt strangely wired; not manic, just weirdly stimulated and uncomfortable. I didn't get any additional benefit. When I tried going back to 60mgs, Cymbalta pooped out completely and I was back at square one. The idea, I think, is that Cymbalta is like Effexor, only more tolerable...plus, its new, and shrinks LOVE having shiny new toys to play with. I don't know what this nonsense with toying with the dosage is about; Eli Lilly's data on dosing is pretty exhaustive and complete; either you take 60mgs and you like it, or you move on to something else. PERIOD. If you're dealing with motivation, you might want to get some dopamine action; very high dose Effexor can do this (375mgs used to be "high-dose," but now some people are on up to 600mgs), but the side-effects suck and some people can't completely withdraw from it b/c of the withdrawal syndrome. Adding a stimulant might help; Ritalin is 1st line for depression, but I personally hate Ritalin with a passion...Adderall worked much, much better. Provigil is another option; if nothing else, it should help with the constant fatigue/exhaustion (it is for narcolepsy, after all); additional benefits are possible, but largely hypothetical. Wellbutrin could work, and it can be added in usual doses to full-dose antidepressant you're already taking...if you already have problems with agitation/anxiety, though, you'll probably want to talk this over AT LENGTH with your prescriber. I've found that SSRIs aren't the best for motivation, probably b/c they indirectly screw with your dopamine. Maybe a different approach to the serotonin would be worthwhile...like Wellbutrin+Remeron. That would also minimize sexual side effeccts. Buspar is usually used for anxiety...even if you're not particularly anxious, Buspar can help augment an antidepressant and help relieve start-up anxiety (if you're taking a novel AD like Remeron, the primary benefits would be anxiety reduction, AD augmentation, and Buspar's weird dopamine agonist properties). Oddly enough, low-dose antipsychotics, when added to antidepressants, can pump up pretty much all the neurotransmitters floating around in your brain, which would (theoretically) help with motivation and the underlying depression. I'd recommend Abilify b/c its more or less weight neutral and the diabetes risk isn't quite as high as it is with, say, Zyprexa...plus, it doesn't screw with hormones like Risperdal does. The important thing would be to keep the dose low (any antipsychotic at high-ish doses can cause apathy, lack of motivation, and considerable cognitive dulling..the last thing anyone needs when they're depressed is a chemical lobotomy) and watch out for tardive dyskinesia and akathisia, both of which can make life HELL. If all else fails, there are the MAOIs...Parnate in particular can be stimulating, so this could be helpful if you can deal w/ the side effects and dietary restrictions (there's going to be an MAOI patch available in a couple months I think, so that option would probably allow for fewer dietary restrictions and more ability to augment with other meds). The more activating TCAs would be an option, but the side effects can be rough and they tend to cause a bit of cognitive impairment during treatment. Good luck!
poster:med_empowered
thread:557557
URL: http://www.dr-bob.org/babble/20050921/msgs/558260.html