Posted by bleauberry on January 19, 2010, at 17:32:47
In reply to milancipran question: Bleauberry or anyone?, posted by floatingbridge on January 18, 2010, at 18:30:05
> How would an exchange of pristiq for milancipran go? Would the Milancipran mitigate the (excruciating) withdrawal of pristiq?
I don't know. It probably would be more help than nothing at all while weaning off pristiq. I would think a better option would be a cross taper. If you want to get away from all the "me too" ADs out there, milnacipran is a good choice. It is actually the only SNRI. Effexor and duloxetine really aren't. Very weak on NE.
>
> Is the milancipran washout a b*tch?In clinical studies milnacipran had surprisingly easy withdrawals compared to other meds such as paxil. The longest I was on milnacipran was 3 weeks. I had maybe one day of a mild withdrawal and that was it. Seems very tame in that regard. I don't know what it is that makes effexor/pristiq so horrid to come off of. My guess is some kind of interplay with the opioid system. I get pretty bad withdrawals lasting about 3 days from just taking duloxetine for about 3 days. Three days on, and then 3 days of withdrawals to pay for it. Geez, some of these meds are just rude. I could take milnacipran with no fear of withdrawals.
>
> I reacted negatively to strattera--pain and reynaurds. Could I expect a similar response to Milancipran?Don't know. Maybe, maybe not. I had decreased pain in some body parts, but increased in another. At times I felt warmer in the hands, other times colder. I think the autonomic effects take months to even out after you've started treatment to rebalance the NE system. Clinical study users at another forum claimed it cured longstanding coldness chilliness stuff, but it took months to cause those adaptations. Depression itself had improved long before that. It's effect on NE is pretty strong, but I don't think as strong or as crude as strattera. The "ants under the skin" comment was probably related to the tingly feeling sometimes. I used to feel that maybe once or twice during the day for a few minutes. I liked it. If that is not what the comment was relating to, then it was probably restlessness/anxiety related, in which case the dose was too high.
As with any medication choice, there really is not accurate prediction of anything. But I think Milnacipran offers a unique opportunity compared to anything else you've taken.
Three big mistakes I see with its use:
1. Doses started too high.
2. Dosage goals based on literature.
3. Doses increased too fast.Remissions have been recorded in at least a couple case studies on pubmed where the dose was only 20mg...which happens to be lower than the recommended starting dose. I liked 12.5mg to 18mg per day.
poster:bleauberry
thread:934250
URL: http://www.dr-bob.org/babble/20100113/msgs/934384.html