Posted by bleauberry on June 2, 2010, at 17:16:16
In reply to Milnacipran/Savella progress, posted by vic80 on June 2, 2010, at 14:25:14
I'm really really sorry you are having such a bad time. I've been in that exact place, and am easily put there again at anytime with any wrong move, so I can certainly relate. You describe it well.
> MIL: Started 18 days ago: at 25mg first 4 days, upped to 25mgx2 daily, till 3 days ago - tachycardia and dyspnea - dosage reduced by pdoc to 25mg once daily.
A decent move, but would have been wiser to split it into 2 or 3 doses instead of one. The halflife is very short, just a few hours.
> I wonder if the emergence of melancholia is a side effect of milnacipran - for the first time I am actually thinking it'd be better to be apathetic than to be hyper emotive.
Melancholia can be an undesired effect of ANY medication that impacts the nervous system. All psych meds can, and do, do that. No matter what the med is, I wouldn't necessarily call it a side effect, but more accurately a direct effect. It is too early since the withdrawal of the other meds to know where to point the finger, but melancholia can be an outcome of starting a med, stopping a med, or being on a wrong med.
>
> I think the best I have felt in months is when I went on MIL and quick tapered lexapro. I wonder what was the magic combo back then....Well, there it is. Low dose lex plus low dose miln. In other parts of the world where there are years of clinical experience with milnacipran in psychiatry, it is combined with SSRIs in the same fashion as combining TCAs with SSRIs. SSRI for the serotonin, Miln for the norepinephrine.
No matter what you do, that once a day dosing thing has to change. The med is too short acting to do any good that way. If a dose is taken at breakfast, it is mostly gone by late afternoon. Cut it in half. Take 12.5 twice, about 6 to 8 hours apart. I know I said it before, the best it treated me was with 6.25mg taken three times per day.
I think there is still some leftover lex withdrarwal readjustment stuff going on too. Lots of chaos going on from that. That stuff can last weeks, even in the backdrop of another medication onboard.
>
> I am literally in the stage of considering going off meds - I seem to be super-hyper sensitive to them somehow.Yeah I sure know that one real well. Others here have reported on it too. Something odd happens when an SSRI is withdrawn. It is quite profound whatever it is. Before going off meds, I think it makes a ton more sense to at least briefly try the suggestions I am about to offer in the last line of this post. It is just pure logic and you are already halfway there anyway.
>
> I wonder how would a drug with half life of 8 hours work with a single daily dose of 25mg.It doesn't. In clinical studies, 50mg twice a day was as good or better than any other antidepressant it was compared to. But 100mg once a day was no better than the placebo group.
>
> Any comments?Spit the dose for multiple dosing. Add back in 2.5mg lex. That's my vote.
poster:bleauberry
thread:949796
URL: http://www.dr-bob.org/babble/20100524/msgs/949799.html