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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Ame Sans Vie on September 7, 2004, at 16:58:01
Hi everyone,
First, as this is the first time I've had access to a functional computer in four days, let me just express my frustration here in this public forum to get that over with: I HATE WINDOWS XP. I HATE MICROSOFT. Okay... feeling better. :-)
The latest news: I see my pdoc tomorrow, which would mark my 28th day on 200mg desipramine, but I think I'd better skip that twenty-eighth dose. It may have exerted some mildly beneficial effects on my mood, but the recent development of heart palpitations seems to warrant a second look at whether this stuff is really worth it, and I think not.
JonW, I hope you don't mind -- I put your name in the subject line because I read above about your experience thusfar with Cymbalta. That's great! What's especially striking to me is the way you described your syndrome as the sort of anxiety/depression combination that allows for all sorts of labels. My three main problems, too, are atypical depression, social phobia and ADD. So, this is addressed to you and anyone else who wants to throw in their opinions: I've had the anxiety, impulsivity, inattention, anergia and amotivation under control for some time now with Klonopin (12mg) and Adderall (120mg); amphetamine tolerance has been halted with Dexalone (60mg); the depression is largely eradicated, and truth be told, I could "get by" quite well just on my current med combo, but I would mind neither the possibility of extra relief from Cymbalta nor the possibility of reducing other medication dosages by adding on this medication. I only have a few questions:
1. Mostly for JonW -- would it be possible for you to draw a comparison in a bit more detail for me between Paxil and Cymbalta? I'm all too familiar with the former, and it would certainly help me to come to my final decision about tomorrow.
2. Are others noticing effects from Cymbalta this early in treatment? I mean, I've read that it appears to be rapid-acting when compared to other ADs, but I was thinking that was just Lilly propaganda... can't help being a skeptic at this point. :-)
3. What are the side effects people are experiencing? I'm not so much concerned with sexual side effects, as Adderall works quite nicely to reverse that. But what about, for example, the emotional blunting so often attributed to Paxil and Luvox?
The second part of my post is something I've wondered these past few days and it's been driving me *insane* that I wasn't able to post it here, lol. Going by my past reaction to Mirapex and my current response to amphetamines, I'm thinking that, at least in my case, some deficiency in dopamine transmission accounts for the pathology of quite a few of my problems. I'm wondering if, by using, for example, a D2 dopamine receptor antagonist like risperidone (yes, I know it also antagonizes 5HT2) would cause increased dopaminergic transmission at other DA receptor sites (i.e., D1, D3, D4 and D5) when taken along with amphetamines... ? Or, for that matter, what about a selective DA agonist? After all, both types of drugs occupy DA receptors, which is the basis of my hypothesis that enhanced transmission elsewhere would result. Or am I entirely on the wrong track? And if this *does* in fact make sense, which drugs would you assume to be better first-line choices for this purpose? I'm currently thinking primarily of Risperdal, Abilify, BuSpar, Mirapex and Requip.
I know I'm asking for a lot of help in this post, so I just want to say in advance that I really appreciate absolutely *any* input! I'm a bit frazzled about what I should do tomorrow. :-\
~Michael
Posted by zeugma on September 7, 2004, at 18:13:55
In reply to Should I try Cymbalta? JonW? / DA-antags + D-amp?, posted by Ame Sans Vie on September 7, 2004, at 16:58:01
hi michael, buspar might work, it is the mildest of the options listed (no AP efficacy, but that's not always a bad thing). The drug has a wildly variable metabolism from person to person, but if I remember correctly you were taking it at one time? Maybe you could get scripts for Buspar and one of the others, and if the Buspar does nothing then you could try the stronger stuff. Pdocs generally see Buspar as 'harmless' and I doubt they would be averse to having you have some on hand.
By the way I am no advocate of buspar, in fact I have always viewed it as the most 'expendable' element of my combinations (currently: 100 mg nortriptyline, 150 mg Provigil, 1 mg clonazepam, 10 mg Ritalin (now THAT is doing nothing) and the 30 mg of buspirone that I've kept after noticing that dumping it, as I have done from time to time, only made me feel worse).
-z
Posted by Ame Sans Vie on September 8, 2004, at 10:30:56
In reply to Re: Should I try Cymbalta? JonW? / DA-antags + D-amp? » Ame Sans Vie, posted by zeugma on September 7, 2004, at 18:13:55
Thanks for the input, zeugma! I was already leaning toward BuSpar prior to posting yesterday for just the reasons you cited. I leave for the doctor in about thirty minutes... guess I'll ask him for a starter dose of Cymbalta and a small prescription for buspirone (since I'll have to pay for that one out-of-pocket).
Thanks again!
~Michael
Posted by zeugma on September 8, 2004, at 20:23:39
In reply to Re: Should I try Cymbalta? JonW? / DA-antags + D-amp? » zeugma, posted by Ame Sans Vie on September 8, 2004, at 10:30:56
Posted by jparsell82` on September 10, 2004, at 13:34:40
In reply to Should I try Cymbalta? JonW? / DA-antags + D-amp?, posted by Ame Sans Vie on September 7, 2004, at 16:58:01
I just wanted to add in that I was contemplating trying a similar thing. I was going to try out a D2 antagonist such as Seroquel combined with Deprenyl to see if I would get benefits from increased output at D1,especially D3,D4, and D5 receptor sites.
> Hi everyone,
>
> First, as this is the first time I've had access to a functional computer in four days, let me just express my frustration here in this public forum to get that over with: I HATE WINDOWS XP. I HATE MICROSOFT. Okay... feeling better. :-)
>
> The latest news: I see my pdoc tomorrow, which would mark my 28th day on 200mg desipramine, but I think I'd better skip that twenty-eighth dose. It may have exerted some mildly beneficial effects on my mood, but the recent development of heart palpitations seems to warrant a second look at whether this stuff is really worth it, and I think not.
>
> JonW, I hope you don't mind -- I put your name in the subject line because I read above about your experience thusfar with Cymbalta. That's great! What's especially striking to me is the way you described your syndrome as the sort of anxiety/depression combination that allows for all sorts of labels. My three main problems, too, are atypical depression, social phobia and ADD. So, this is addressed to you and anyone else who wants to throw in their opinions: I've had the anxiety, impulsivity, inattention, anergia and amotivation under control for some time now with Klonopin (12mg) and Adderall (120mg); amphetamine tolerance has been halted with Dexalone (60mg); the depression is largely eradicated, and truth be told, I could "get by" quite well just on my current med combo, but I would mind neither the possibility of extra relief from Cymbalta nor the possibility of reducing other medication dosages by adding on this medication. I only have a few questions:
>
> 1. Mostly for JonW -- would it be possible for you to draw a comparison in a bit more detail for me between Paxil and Cymbalta? I'm all too familiar with the former, and it would certainly help me to come to my final decision about tomorrow.
>
> 2. Are others noticing effects from Cymbalta this early in treatment? I mean, I've read that it appears to be rapid-acting when compared to other ADs, but I was thinking that was just Lilly propaganda... can't help being a skeptic at this point. :-)
>
> 3. What are the side effects people are experiencing? I'm not so much concerned with sexual side effects, as Adderall works quite nicely to reverse that. But what about, for example, the emotional blunting so often attributed to Paxil and Luvox?
>
> The second part of my post is something I've wondered these past few days and it's been driving me *insane* that I wasn't able to post it here, lol. Going by my past reaction to Mirapex and my current response to amphetamines, I'm thinking that, at least in my case, some deficiency in dopamine transmission accounts for the pathology of quite a few of my problems. I'm wondering if, by using, for example, a D2 dopamine receptor antagonist like risperidone (yes, I know it also antagonizes 5HT2) would cause increased dopaminergic transmission at other DA receptor sites (i.e., D1, D3, D4 and D5) when taken along with amphetamines... ? Or, for that matter, what about a selective DA agonist? After all, both types of drugs occupy DA receptors, which is the basis of my hypothesis that enhanced transmission elsewhere would result. Or am I entirely on the wrong track? And if this *does* in fact make sense, which drugs would you assume to be better first-line choices for this purpose? I'm currently thinking primarily of Risperdal, Abilify, BuSpar, Mirapex and Requip.
>
> I know I'm asking for a lot of help in this post, so I just want to say in advance that I really appreciate absolutely *any* input! I'm a bit frazzled about what I should do tomorrow. :-\
>
> ~Michael
Posted by zeugma on September 10, 2004, at 20:20:01
In reply to Re: Should I try Cymbalta? JonW? / DA-antags + D-amp? » zeugma, posted by Ame Sans Vie on September 8, 2004, at 10:30:56
michael, i hope the buspar is doing good things for you. it's been good for me, but when the Provigil started giving me problems with orthostasis, i scrapped the morning dose of buspirone and am keeping it currently only for sleep purposes. In the scheme of things, I would say that Provigil is far more important,in my current situation, but I hope the buspirone is adding something positive to your mix.
-z
Posted by Paul_d_234 on September 11, 2004, at 9:19:26
In reply to buspar addendum, and hope you're doing wel, posted by zeugma on September 10, 2004, at 20:20:01
Does Buspar cause weight gain or sexual side affects? I used to use Xanax for anxiety / panic - what does Buspar do?
Posted by zeugma on September 12, 2004, at 10:31:13
In reply to Re: buspar addendum, and hope you're doing wel, posted by Paul_d_234 on September 11, 2004, at 9:19:26
> Does Buspar cause weight gain or sexual side affects? I used to use Xanax for anxiety / panic - what does Buspar do?
Buspar is marketed as an anxiolytic, but I would not put it in the same class as a benzodiazepine in terms of reducing anxiety. I would say it has more of an antidepressant effect.
It is actually used to counteract SSRI sexual side effects. On its own it seems to reliably increase libido.
For some people it has a sedating effect, and sedating drugs generally cause weight gain.
-z
Posted by JonW on September 14, 2004, at 20:46:02
In reply to Should I try Cymbalta? JonW? / DA-antags + D-amp?, posted by Ame Sans Vie on September 7, 2004, at 16:58:01
> 1. Mostly for JonW -- would it be possible for you to draw a comparison in a bit more detail for me between Paxil and Cymbalta? I'm all too familiar with the former, and it would certainly help me to come to my final decision about tomorrow.
Hi Michael! I'm really sorry it's taken me so long to reply to this, but I just noticed your post today. As for a comparison of Paxil and Cymbalta, to me, they feel very similar. It's like Paxil w/o the side-effects. Well, not entirely. Both make me a little drowsy, but Cymbalta doesn't seem to interfere with memory, etc. The biggest thing that both Cybalta and Paxil do for me is help with social anxiety. They both have that effect of creating those moments where the lack of anxiety or lack of inhibition surprise you. Or maybe a lack of embarasment when you would expect yourself to feel that way. Does that make any sense at all??? Anyway, it's not a solution to the problem, but an important part. I qualify this with the fact that I'm still on both Lexapro and Cymbalta and having great difficulty getting off of Lexapro. I should be able to get off of it completely at some point and then I'll be able to say these things for sure. My pdoc is going to increase my Cymbalta for a bit, and see if that makes it possible to stop the Lexapro. I hope so!
> 3. What are the side effects people are experiencing? I'm not so much concerned with sexual side effects, as Adderall works quite nicely to reverse that. But what about, for example, the emotional blunting so often attributed to Paxil and Luvox?
Since starting Cymbalta, I'm able to experience *more* pleasure from the things I do. I really appreciate things, etc. The only side-effects I've experienced are somnolence, increased sweating, and slightly delayed orgasm.
> I know I'm asking for a lot of help in this post, so I just want to say in advance that I really appreciate absolutely *any* input! I'm a bit frazzled about what I should do tomorrow. :-
Sorry I didn't reply before your appointment, but what did you end up doing?
Jon :)
This is the end of the thread.
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