Posted by med_empowered on January 2, 2006, at 19:30:56
In reply to Re: 'Tain't that easy, I'm afraid » Racer, posted by Phillipa on January 2, 2006, at 18:44:53
I think docs like Cymbalta more b/c 1) its newer, which is always nice and 2) the dosing schedule makes it really easy to use, especially in Primary Care (GPs write 70% of all psychotropic RXs in the US). Cymbalta is an equipotent reuptake inhibitor of norepinephrine and serotonin; Effexor starts out hitting only serotonin, then hits norepinephrine, and then hits a bit of dopamine, too.
Originally, Effexor was designed to go anywhere from 75mgs/day to 375mgs/day...now, some people go up to about 600mgs/day.
If Cymbalta is working somewhat, you could try upping the dose (I took 90mgs, some people take up to 120mgs) and/or augmenting. If you need more stimulation, I would think adding something like Wellbutrin, maybe Pamelor, would be helpful; Provigil might also be good, but its awfully expensive. If you're having sexual side effects or anxiety, add-on BuSpar might help (and boost the AD effects, as well). Some combos have their own names now, like "California Rocket Fuel"--Effexor, Remeron (you could just pop on 30+mgs Remeron to your Cymbalta and see how that goes..it'd be a similar combo). If newer meds fail, you could add some old-school stuff--benzos, amphetamines, that kind of thing. Atypical antipsychotics are also an option, but I think those should be used more sparingly than they are being used now.
I hope everything works out for you. Good luck!
poster:med_empowered
thread:594319
URL: http://www.dr-bob.org/babble/20051231/msgs/594487.html