Posted by SLS on July 22, 2015, at 7:32:34
In reply to Re: Effexor or Cymbalta, posted by kribensis on July 21, 2015, at 22:12:34
> I seriously hate this. I am having a melt down today- I try and keep myself together and I do everything that a person *should* do to help themselves, exercise, eat well, get to bed early, meditate, etc. and I STILL have this issue. And the only time in my life I have felt basically "normal" was those few years on effexor. It just feels like such a struggle and now I have anxiety about meds being hard on the liver or heart, etc. It just sucks that it has to be this hard. Because I have done everything that I can think of to help myself, I know this must be a physical brain type issue (runs in my family) but it totally sucks and I'm down and feeling sorry for myself. Even if I do find a med that helps, I am really only guaranteed to feel okay for a period of time, then have to go through the hassle of weaning off and dealing with discontinuation symptoms. This just isn't fair. I feel like I'm in slow motion when I'm like this, my brain doesn't work, I can't speak clearly, I feel like I can't focus properly and everything just is slow, slow slow...
You describe severe depression very well. Some of the following suggestions will not be palatable, but I think you should at least be aware of them.
1. Aches and pains are sometimes symptoms of the depressive disorder itself. Cymbalta is known to help with these. I don't know if the presence of pain is an indicator of responsivity to Cymbalta, but the drug is still an effective drug, and a reasonable choice.
2. As per your description, you might have psychomotor retardation as a prominent feature of your illness. This presentation is often responsive to tricyclics (TCA). I am having some luck with nortriptyline in combination with other drugs. Desipramine is a stronger noradrenergic drug, and can be helpful. It usually does not produce weight-gain as nortriptyline sometimes can. I actually did relatively well with Effexor after it was augmented with nortriptyline.
3. At 300 mg/day, your dosage of Effexor was still below the maximum recommended by the drug manufacturer (375 mg/day). Some people don't do well until the dosage is brought up to 600 mg/day. If you do go back to Effexor, you might consider going higher than 300 mg/day.
http://www.rxlist.com/effexor-drug/indications-dosage.htm
4. If you are partially responsive to either Effexor or Cymbalta, you might consider continuing the drug and building a regime around it. You can add:
- Wellbutrin
- Remeron
- Low-dose lithium (300 - 600 mg/day)
- Abilify
- Lamictal
- TCA5. Paxil is often overlooked. It is very effective, and can produce a response when no other SSRI can. However, it is likely to produce weight-gain.
6. At some point, you might need to consider MAOIs. Not all doctors are comfortable using them for lack of experience and their reliance upon the patient to be vigilant in following food and medication restrictions.
- Nardil is great when comorbid anxiety disorders are present, but weight-gain is to be expected. I have more trouble with hypotension with Nardil.
- Parnate is usually chosen for a case like yours where anergia or psychomotor retardation are present.
- Marplan is not usually chosen first, but I found it to be a clean and gentler drug that did not produce weight-gain.I will be interested to know what you decide. I hope you hit the bullseye with just one drug.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1080685
URL: http://www.dr-bob.org/babble/20150629/msgs/1080697.html