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Dr. Bob is Robert Hsiung, MD,
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Posted by nmk on September 8, 2004, at 10:12:29
In reply to Re: Milnacipran » nmk, posted by SLS on September 7, 2004, at 18:51:41
Thanks for all of the advice, I do appreciate it. I meet with my doc at the end of the month and I will raise these questions with him.
Please keep the updates coming and I wish you the best.
Nicole
Posted by aloe on September 8, 2004, at 11:23:08
In reply to Re: Cymbalta (duloxetine) - report, posted by awatts on September 4, 2004, at 14:36:47
I'll be checking in, too, for updates on others Cymbalta experiences, and to leave reports on my own. I am starting Cymbalta today, with the hope that the sexual side effects won't be as bad as with others. I just hope this isn't another case of the Lexapro debacle, where the manufacturer hypothesizes that the sexual side effects will be minimal, despite the fact that it has the same active ingredient as Celexa. I wouldn't think it would be any surprise that Lexapro showed the same sexual effects as Celexa.
The insert that comes with Cymbalta may also be constructed to "disguise" some of the sexual side effects. If you look, instead of having just one category for "sexual side effects", the insert separates into their own categories the following dysfunctions: Orgasm abnormal, ejaculatory dysfunction, libido decreased, erectile dysfunction, ejaculation delayed. That way when you see 2% for one category you think, "Oo! Only a 2% chance of abnormal orgasms. That doesn't sound too bad compared to Celexa's (or any other SSRI's) 30% chance of general sexual dysfunction." But add up the numbers in Cymbalta's categories and suddenly you've got a number larger then 2%.
Also noticeable from the package insert is that sexual dysfunction was much more prevalent in males. Sorry guys.
I don't know how much I believe these package inserts,though. I have experience in the science field, and I am well aware of how numbers can have various interpretations depending on which biased eye is looking at them. Plus, the trials used to acquire the numbers aren't as free from variables as the people conducting the studies like to think they are.
I'd better stop now. Sorry if I just bored you all to death.
> I'm watching your Cymbalta progress with great interest - please keep posting, everybody. I will be starting Cymbalta soon - as soon as I get all of the Effexor out of my system.
>
> Effexor XR was working for me (150mg), but I decided that I was no longer willing to be shut down sexually. My hope is that Cymbalta will work on the depression/motivation as well as Effexor did WITHOUT making orgasm impossible.
>
> If anyone notices adverse sexual effects from Cymbalta, please post!
>
> Thanks.
Posted by 4WD on September 8, 2004, at 13:58:33
In reply to Re: what is Milnacipran? » SLS, posted by Racer on September 7, 2004, at 15:44:08
> I'm at 60, since last Thursday. Today I'm jumping out of my skin again, but still can't seem to *do* anything much. That's still an improvement over the weekend, though: I spent most of it either asleep or just immobilized on the sofa. No real energy -- beyond the agitation -- no motivation, no ability to follow through, and for most of the weekend I just didn't feel as if living was worth it.
>
> Again, this is still adjustment phase, which I know, but unless things start to show signs of turning around very soon -- like less restlessness and jitteriness, and less sedation and amotivation -- I'm not all that hopeful about it. The combination of being keyed up and feeling so paralysed is not a good one for me -- it tends to be the thing that leads to much increased suicidal impulses. (Which is going on right now, by the way.)
>
> The good news is that I've got some support from a couple of someones here who keeps reminding me that I really have been through hell for an extended visit, so everything is still pretty distorted. One of them keeps reminding me that it might still turn around, and encouraging me to keep trying. So far, I have. More out of inertia, I think, but the end result is the same. I'm giving it a chance, and next week I see Dr NoName again and can discuss it with him. So far, I've been able to say, "it's only a week more, surely I can manage it that long?" Part of the problem is that I get such tunnel vision, you know? It seems as if this moment is all that's ever existed, so if it's horrible, then it's always going to be horrible. The most insidious part of the disease process, I guess.
>
> Thanks for your support, Scott. Hope you had a good weekend -- without any bull sharks ;-)
Racer,Sorry to butt in but I wanted to tell you that I was experiencing a lot of anxiety and grim/bleak outlook the last couple of days on Cymbalta. After looking back through my calendar, I realized that I had felt the same way when I switched from Effexor to Wellbutrin and from Effexor to Paxil. It occurred to me that just maybe the Wellbutrin and the Paxil hadn't made me so anxious and bad-feeling. Maybe it was the Effexor withdrawal. So the last couple of days, I've added a small amount of Effexor back in (in addition to the Cymbalta) and I am feeling much much better today. I don't know what you were on before but could it be possible the agitation, etc is a reaction to d/cing the previous med?
marsha
Posted by jrbecker on September 8, 2004, at 14:19:50
In reply to Re: Cymbalta (duloxetine) - report, posted by aloe on September 8, 2004, at 11:23:08
> I'll be checking in, too, for updates on others Cymbalta experiences, and to leave reports on my own. I am starting Cymbalta today, with the hope that the sexual side effects won't be as bad as with others. I just hope this isn't another case of the Lexapro debacle, where the manufacturer hypothesizes that the sexual side effects will be minimal, despite the fact that it has the same active ingredient as Celexa. I wouldn't think it would be any surprise that Lexapro showed the same sexual effects as Celexa.
>
> The insert that comes with Cymbalta may also be constructed to "disguise" some of the sexual side effects. If you look, instead of having just one category for "sexual side effects", the insert separates into their own categories the following dysfunctions: Orgasm abnormal, ejaculatory dysfunction, libido decreased, erectile dysfunction, ejaculation delayed. That way when you see 2% for one category you think, "Oo! Only a 2% chance of abnormal orgasms. That doesn't sound too bad compared to Celexa's (or any other SSRI's) 30% chance of general sexual dysfunction." But add up the numbers in Cymbalta's categories and suddenly you've got a number larger then 2%.
>
> Also noticeable from the package insert is that sexual dysfunction was much more prevalent in males. Sorry guys.
>
> I don't know how much I believe these package inserts,though. I have experience in the science field, and I am well aware of how numbers can have various interpretations depending on which biased eye is looking at them. Plus, the trials used to acquire the numbers aren't as free from variables as the people conducting the studies like to think they are.
>
> I'd better stop now. Sorry if I just bored you all to death.
>
> > I'm watching your Cymbalta progress with great interest - please keep posting, everybody. I will be starting Cymbalta soon - as soon as I get all of the Effexor out of my system.
> >
> > Effexor XR was working for me (150mg), but I decided that I was no longer willing to be shut down sexually. My hope is that Cymbalta will work on the depression/motivation as well as Effexor did WITHOUT making orgasm impossible.
> >
> > If anyone notices adverse sexual effects from Cymbalta, please post!
> >
> > Thanks.
>If it's any consolation, both Celexa, and Lexapro (a little less so), left me numb. Even at minute doses, I had extreme anorgasmia.
Effexor was a little better for me sexually (both libido and orgasmically, but not much).
Cymbalta has been a pleasant surprise so far. I experience little dysfunction and have a slightly increased libido compared to when I was on Effexor. But I should note that I am currently only taking 30mg daily.
Posted by iris2 on September 8, 2004, at 22:09:35
In reply to Re: Cymbalta (duloxetine) - report » iris2, posted by SLS on September 7, 2004, at 9:27:54
Hi Scott,
Thanks. I have been posting more often.
It is great that you are here.
Well you do a lot of work here so I would not say you are not working :) :)irene
Posted by Nohope on September 9, 2004, at 3:57:06
In reply to Re: what is Milnacipran?, posted by SLS on September 7, 2004, at 13:09:05
> Milnacipran is a French SNRI drug that has been around for quite a few years. I have never spoken to anyone who has worked with it, so I don't have an impression as to its efficacy or side effect profile.
>
>
> - ScottI was on milnacipran for a few months earlier this year (dose varied: 75-150mg).
I found it extremely tolerable. Some annoying start up side effects such as insomnia and nausea, but these passed. Very few side effects remained after 2-3 weeks.
For me, it was more potent as an antidepressant than the SSRIs, but that's not really surprising since I don't respond well to SSRIs. Unfortunately, it had no effect on my very strong fatigue (atypical depression guy here...) and I could only work and sleep, so I had to ditch it. It was moderately effective for my panic.
There is a rather large study suggesting that milnacipran was similar in efficacy to imipramine and superior to fluvoxamine. Maybe it's true, but I've never taken imipramine, so I can't say for sure (anyway, I am only a sample size of n=1).
Overall, it was definitely better than nothing and very tolerable, but not good enough for me.
(BTW check out its structure: hauntingly similar to Parnate)
Nohope
Posted by Minnie-Haha on September 9, 2004, at 15:18:22
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by KaraS on September 7, 2004, at 18:06:25
> "Found an article on depression and inflammation - that seems to be the core of what has helped me, doing everything I can to get inflammation down!
>
> http://66.102.9.104/search?q=cache:49TDZcsEWEQJ:www.medscape.com/viewarticle/438509+depression+interleukin+1+new+scientist&hl=en&ie=UTF-8
>
> also found this with interleukin 1 and it's possible link with hashimoto's
>
> http://www.annalsnyas.org/cgi/content/abstract/876/1/221
>
> Antimicrobial and immunoregulatory functions of lactoferrin and its potential therapeutic application.
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12542852
>
>
> Take care,
> KaraSomebody out there who can tell me what these reports mean? I tried to read 'em, but fell down mentally. I have thyroid nodules, was briefly treated with a synthetic thyroid hormone (to try to shrink the nodules), but had to stop because it pushed me into a hyperthyroid state and with my months-long battle with insomnia, anxiety, and depression, I just could tolerate increasing those symptoms. I don't have fibrolyalgia, but the rheumatologist said I have enough symptoms of that to warrant taking a small dose of a TCA at night to see if it helps me sleep (and thereby improves my mood). I just keep feeling like there's a hormonal or inflammatory or some kind of systemic answer like that to the puzzle, though tests have turned up nothing yet.
Posted by Minnie-Haha on September 9, 2004, at 15:31:22
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 7, 2004, at 8:50:27
> I still think Cymbalta will be a great drug for many people. I would not discourage anyone from trying it at this point.
>
> - ScottI just spent an hour or more following this thread and I want to thank you for taking the time to share your recent experiences with Cymbalta, as well as just your general knowledge, care, concern, etc. My doctor recommended Cymbalta today, but I told him I wanted to learn more about it. My official DX are BP2 and OCD, but I'm not sure they're correct. At any rate, my main complaints this past year have been insomnia, anxiety, and depression. My old pdoc didn't want to give me anti-depressants, so I've been muddling through with Trileptal and Ativan. The new pdoc suggested the Cymbalta, but also said my PCP's idea to try a low dose of Elavil at night might be worth a try, to see if it helps me sleep and see if that in turn improves my mood. (I briefly tried Ambien, once again just to see if sleep alone would improve my mood, but after a couple of nights, it didn't really help me sleep through and my daytime mood went in the toilet.) I think I will try the Elavil for a while, but if no real improvement, perhaps I'll give Cymbalta a go.
Thanks again.
Posted by SLS on September 9, 2004, at 16:27:53
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 7, 2004, at 8:50:27
9/9/2004
Day 21
6 days at 30mg
14 days at 60mg60mg (30mg b.i.d.)
Oh, well. I wish I could say that I am at all improved right now, but I really can't. I was feeling better a week ago.
I am not experiencing any physical or cognitive side effects at the moment.
- Scott
Posted by pseudonym on September 10, 2004, at 0:53:33
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 9, 2004, at 16:27:53
Why are you taking it twice daily? I thought that Lilly recommeded one daily @ 60 mg.
Posted by alesta on September 10, 2004, at 1:12:10
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 9, 2004, at 16:27:53
hi, scott,
i don't know if you didn't see my question before, but i was wondering how you did on parnate and/or nardil???
amy:)
Posted by SLS on September 10, 2004, at 7:10:23
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by alesta on September 10, 2004, at 1:12:10
Hi Amy.
> i don't know if you didn't see my question before, but i was wondering how you did on parnate and/or nardil???
The only thing that ever worked for me was a combination of Parnate + desipramine. Unfortunately, my doctor at the time discontinued it and I never responded to it again. I am partially responsive to Nardil, but not enough to stay on it.Thanks.
- Scott
Posted by SLS on September 10, 2004, at 7:16:54
In reply to Re: Cymbalta (duloxetine) - report, posted by pseudonym on September 10, 2004, at 0:53:33
> Why are you taking it twice daily? I thought that Lilly recommeded one daily @ 60 mg.
Hi P.
I have 30mg capsules, so I figured I'd follow a b.i.d. schedule given the short half-life.
This is how the manufacturer suggests dosing:
"Cymbalta should be administered at a total dose of 40 mg/day (given as 20 mg BID) to 60 mg/day (given either once a day or as 30 mg BID) without regard to meals."
I'll think about trying the 60mg in the morning. I guess it's possible that it might be more effective. You never know. I sort of doubt it, though. I think Lilly might be suggesting the once-daily dosing as convenience measure to help sell the product.
- Scott
Posted by alesta on September 10, 2004, at 17:06:33
In reply to Re: Cymbalta (duloxetine) - report » alesta, posted by SLS on September 10, 2004, at 7:10:23
thanks for your reply, scott..i appreciate it..have you tried magnesium supplementation with quality supplements, and have you had your hormone and thyroid levels checked? (guys can have hormone problems, too..) i ask all these questions b/c i don't think a depression gene has yet been identified, so i am trying to look at all the possible factors that might contribute to your depression, since you are so treatment-resistant..i also posted a thread "ppl with treatment-resistant depression or any depression please read". i had you in mind when i posted it..please get back to me...:)
amy:)
Posted by Minnie-Haha on September 10, 2004, at 17:23:14
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by alesta on September 10, 2004, at 17:06:33
> i also posted a thread "ppl with treatment-resistant depression or any depression please read". i had you in mind when i posted it..please get back to me...:)
>
> amy:)so where is this post? i can't find it.
Posted by alesta on September 10, 2004, at 17:40:12
In reply to Re: Cymbalta (duloxetine) - report, posted by Minnie-Haha on September 10, 2004, at 17:23:14
hi, minnie:),
this should be the link:
http://www.dr-bob.org/babble/20040904/msgs/387334.html
amy;
Posted by SLS on September 10, 2004, at 17:47:19
In reply to Re: Cymbalta (duloxetine) - report » SLS, posted by alesta on September 10, 2004, at 17:06:33
Hi Amy.
Thanks for trying so hard.
:-)
I really do appreciate it. I hope I can make it up to you somehow.
I read the piece on magnesium about 1½ years ago. I gave it a try. It made me sleepy, but that's about it. It was well worth the try, though. A few people here reported great success with it.
I have added both T3 and T4 thyroid hormones to my treatment, despite testing normal. T4 helped a little bit initially, but not enough to stick with.
I have only tried a few of the alternative treatments - magnesium, fish oil, inositol, S-AMe, tyrosine, vitamins, and a few others. I just don't get the feeling that's where my answer lies. I try to keep an open mind, though. I take a peek at the alternative board every now and then. There are so many different "supplements" discussed, it's hard to keep up with.
- Scott
Posted by alesta on September 10, 2004, at 18:16:11
In reply to Re: Cymbalta (duloxetine) - report » alesta, posted by SLS on September 10, 2004, at 17:47:19
you're most welcome, scott..:)..i'm sorry i can't be of more help...it must be awful to feel as you do day in and day out..
i wonder if there is a blood test you could take to figure out the levels of various vitamins in your body. also, there is a saliva test to check hormone levels...
anyway, hope you can find a solution..you are still a charming presence..even depressed..:)
take care :),
amy
Posted by SLS on September 13, 2004, at 7:26:04
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 9, 2004, at 16:27:53
9/13/2004
Day 25
6 days at 30mg
19 days at 60mg60mg (30mg b.i.d.)
No improvement. I don't anticipate the reappearance of the antidepressant response I experienced two weeks ago.
No side effects with the possible exception of a reduction of libido. It is difficult to tell because the depression itself might be causing it. I'm also pretty bummed-out about things right now, so I suppose that could account for it.
I hope others will do well on this drug. The reports being posted are encouraging.
- Scott
Posted by jrbecker on September 13, 2004, at 11:06:44
In reply to Re: Cymbalta (duloxetine) - day 10, posted by jrbecker on September 2, 2004, at 12:26:28
here's my 3rd report....
30mg daily, in AM.
I've learned to keep my expectations low with any new drug trial, but I've been pleasantly surprised at my slow but sure progress these last few weeks.
Some mild sleepiness throught the first 3-7 hours after dosing. Anxiety is nil, agitation neglible, irritabilty very little, a noticable delayed orgasm (beats the total anorgasmia I have on other meds), but it hasn't put a damper on my libido. This is a side effect profile that has been unbelievable charitable so far in comparison to the other SSRI/SNRIs.
Socializing more, exercising more and generally less hypervigilint.
JB
> here's my 2nd report...
>
> still taking 30mg in the morning. as far as side effects, some slight sleepiness throughout the early part of the day and some very mild sleep disruption a few nights. As for the daytime sleepiness, I'd guess that it's gotten about 50% better since I started, so this is hopefully good news for most of you.
>
> I have noticed a gradual improvement of my affect anxiety, and motivation in this last week and a half -- nothing phenomenal but definitely significant.
>
> Dare I up it 40mg? I think the deicision will rest on whether the 20mg tablets will be available to me anytime soon. My main concern in doing this would be any increase in apathy that might go along with it. But so far, I've felt more motivated than compared with my old dose of effexor, so maybe an increase might help rather than hinder my inner drive.
>
> Developing....
>
>
>
>
>
>
> > here's my first report...
> >
> > taking 30mg once daily in the morning. only side effects are some mild somnolence about 3-6 hours after dosing. Some nights, I have experienced a little sleep disruption and initial insomnia on some nights. But I've been able to still make it to the gym, so I can't say that there's been any decrease in my overall enegry level. To my relief, I have not experienced any increase in anxiety or agitation. As Scott mentioned, the drug is rather "clean."
> >
> > So far, I must admit that this is a welcomed improvement over my prior regimen of Effexor 37.5mg.
> >
> > I plan to stick with 30mg for a couple more weeks.
> >
> > I haven't ruled out upping to 40mg (20mg BID) or even decreasing to 20mg. As you might guess, I'm fairly med sensitive.
> >
> > JB
> >
>
>
Posted by 4WD on September 13, 2004, at 21:01:05
In reply to Re: Cymbalta (duloxetine) - day 21, posted by jrbecker on September 13, 2004, at 11:06:44
> here's my 3rd report....
>
> 30mg daily, in AM.
>
> I've learned to keep my expectations low with any new drug trial, but I've been pleasantly surprised at my slow but sure progress these last few weeks.
>
> Some mild sleepiness throught the first 3-7 hours after dosing. Anxiety is nil, agitation neglible, irritabilty very little, a noticable delayed orgasm (beats the total anorgasmia I have on other meds), but it hasn't put a damper on my libido. This is a side effect profile that has been unbelievable charitable so far in comparison to the other SSRI/SNRIs.
>
> Socializing more, exercising more and generally less hypervigilint.
>
> JB
>
> > here's my 2nd report...
> >
> > still taking 30mg in the morning. as far as side effects, some slight sleepiness throughout the early part of the day and some very mild sleep disruption a few nights. As for the daytime sleepiness, I'd guess that it's gotten about 50% better since I started, so this is hopefully good news for most of you.
> >
> > I have noticed a gradual improvement of my affect anxiety, and motivation in this last week and a half -- nothing phenomenal but definitely significant.
> >
> > Dare I up it 40mg? I think the deicision will rest on whether the 20mg tablets will be available to me anytime soon. My main concern in doing this would be any increase in apathy that might go along with it. But so far, I've felt more motivated than compared with my old dose of effexor, so maybe an increase might help rather than hinder my inner drive.
> >
> > Developing....
> >
> >
> >
> >
> >
> >
> > > here's my first report...
> > >
> > > taking 30mg once daily in the morning. only side effects are some mild somnolence about 3-6 hours after dosing. Some nights, I have experienced a little sleep disruption and initial insomnia on some nights. But I've been able to still make it to the gym, so I can't say that there's been any decrease in my overall enegry level. To my relief, I have not experienced any increase in anxiety or agitation. As Scott mentioned, the drug is rather "clean."
> > >
> > > So far, I must admit that this is a welcomed improvement over my prior regimen of Effexor 37.5mg.
> > >
> > > I plan to stick with 30mg for a couple more weeks.
> > >
> > > I haven't ruled out upping to 40mg (20mg BID) or even decreasing to 20mg. As you might guess, I'm fairly med sensitive.
> > >
> > > JB
> > >
> >
> >
>JB
I am so happy for you. Cymbalta is treating me pretty well, too. (30mg day) tapering Effexor, Klonopin as needed for anxiety.
How are you tapering your Effexor? What was your dose? I am finding that coming off the Effexor is making me very anxious, necessitating the Klonopin. Perhaps I am trying to taper too fast? Have you experienced any ringing in your ears or pressure in your head?
Marsha
>
Posted by 4WD on September 13, 2004, at 21:19:19
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 13, 2004, at 7:26:04
> 9/13/2004
>
> Day 25
>
> 6 days at 30mg
> 19 days at 60mg
>
> 60mg (30mg b.i.d.)
>
> No improvement. I don't anticipate the reappearance of the antidepressant response I experienced two weeks ago.
>
> No side effects with the possible exception of a reduction of libido. It is difficult to tell because the depression itself might be causing it. I'm also pretty bummed-out about things right now, so I suppose that could account for it.
>
> I hope others will do well on this drug. The reports being posted are encouraging.
>
>
> - ScottScott I am sorry it isn't working for you. I wish so much you could find something that would do it for you. I know people probably give you all sorts of suggestions - I don't have any. But I will pray for you.
Marsha
Posted by pseudonym on September 13, 2004, at 23:13:25
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 13, 2004, at 7:26:04
From a prior post you mentioned you were using Abilify as anti-depressant,correct, not as an anti-psychotic, or at least to keep you from the "abyss". If that is correct, what is life like for you without Abilify?
Posted by karaS on September 14, 2004, at 0:39:20
In reply to Re: Cymbalta (duloxetine) - report, posted by Minnie-Haha on September 9, 2004, at 15:18:22
> > "Found an article on depression and inflammation - that seems to be the core of what has helped me, doing everything I can to get inflammation down!
> >
> > http://66.102.9.104/search?q=cache:49TDZcsEWEQJ:www.medscape.com/viewarticle/438509+depression+interleukin+1+new+scientist&hl=en&ie=UTF-8
> >
> > also found this with interleukin 1 and it's possible link with hashimoto's
> >
> > http://www.annalsnyas.org/cgi/content/abstract/876/1/221
> >
> > Antimicrobial and immunoregulatory functions of lactoferrin and its potential therapeutic application.
> >
> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12542852
> >
> >
> > Take care,
> > Kara
>
> Somebody out there who can tell me what these reports mean? I tried to read 'em, but fell down mentally. I have thyroid nodules, was briefly treated with a synthetic thyroid hormone (to try to shrink the nodules), but had to stop because it pushed me into a hyperthyroid state and with my months-long battle with insomnia, anxiety, and depression, I just could tolerate increasing those symptoms. I don't have fibrolyalgia, but the rheumatologist said I have enough symptoms of that to warrant taking a small dose of a TCA at night to see if it helps me sleep (and thereby improves my mood). I just keep feeling like there's a hormonal or inflammatory or some kind of systemic answer like that to the puzzle, though tests have turned up nothing yet.
>I didn't even try to read them. I just forwarded them to Scott because I thought they were about something he had been looking into. Sorry.
-K
Posted by SLS on September 14, 2004, at 6:31:32
In reply to Re: Cymbalta (duloxetine) - report, posted by 4WD on September 13, 2004, at 21:19:19
Thanks, Marsha.
:-)
- Scott
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