Posted by Racer on January 20, 2008, at 21:09:53
In reply to Trusting Drs figuring out what's wrong, posted by Irma on January 20, 2008, at 12:50:03
Welcome to Babble! If I'd been able to have children, I always planned to name a daughter Irma, so I particularly like your name.
As for the Cymbalta/Effexor combination your doctor is suggesting, that just doesn't sound right to me. They're both the same class of drug, and adding them to one another doesn't sound all that reasonable to me. In fact, because they're both serotinergic medications, it sounds downright dangerous to me. I strongly urge you to ask him about it, at least -- and really, I urge you to consider seeing a psychiatrist for psychiatric drugs. They're just more experienced with them, and that makes such a difference.
Two serotinergic drugs at once can cause a reaction called serotonin syndrome, which can be fatal. It's rare, but why take a chance?
As for what you've said so far, my best advice is to educate yourself about the use of antidepressants, and about depression in general. The thinking on most of these drugs is to continue taking them for at least six months past the point of remission. That reduces the risk of relapse. Tapering off, rather than cold turkey, is also recommended, to prevent rebound depression. If you're medicating depression which has become recurrent, the best recommendation is to stay on the medication for about two years, then taper off and see how you do. Stopping and starting medications is usually counter-productive -- you probably haven't gotten the optimal effect of the medication, and then stopping it you get both rebound depression and probably a high rate of relapse, as well. Many of the side effects of medications for depression can be mitigated with adjunctive medications, and it's worth discussing those options with your doctor, too. In fact, that's one of the best reasons to see a psychiatrist for psychiatric medications: you're more likely to find someone with more experience mitigating these side effects.
"Depression" can mean a lot of different things -- the symptoms involved vary a lot, and which symptoms are most problematic for any one person may vary over time. The medications out there right now often vary in how well they treat specific symptom clusters, which means that your reactions to medications may help predict which medications are most likely to be helpful for you. The sorts of symptoms you're describing sound to me as though you may have a somewhat more complex picture than most GPs are equipped to handle. That said, I think it's probable that sticking with Cymbalta, at a higher dose, is probably your best bet. MANY adverse effects pass after you've adjusted to a medication. If you can get through the first four to eight weeks, you're likely to find that most of the problems you started out with are gone -- and considering how beneficial treatment for depression can be, it's worth it if it works out.
After reading your post, I'd also recommend both psychotherapy, because it can be more helpful than medications for addressing some of the issues you've brought up, and also discussing pot with your doctor. Pot is a drug, meaning it's going to interact with the medications you're being prescribed. If you don't trust your doctor enough to discuss it with him, it might be a sign that this isn't a good fit for you and another doctor might be in order. (By the way, firing doctors can leave you with quite a good feeling of strength and power. I recommend trying it sometime.)
I hope that helps, and again -- welcome to Babble!
poster:Racer
thread:807929
URL: http://www.dr-bob.org/babble/20080114/msgs/808036.html