![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Berberis on January 25, 2006, at 14:10:31
Pdoc has suggested I try Cymbalta to replace Wellbutrin. He CLAIMS there's a low side effect profile and no weight gain issue. How is it different from SSRI's (of which I've taken plenty)? If you've taken it, would you share with me your experience?
Posted by Racer on January 25, 2006, at 18:36:27
In reply to Cymbalta, posted by Berberis on January 25, 2006, at 14:10:31
Cymbalta is not an SSRI, it's an SNRI -- that's the quick and dirty answer to your stated question, "How is it different from SSRI's" It's a whole 'nother class of drug.
I don't think that's the question you're actually asking, of course, but just in case...
Anyway, Cymbalta is part of the same class of drugs as Effexor, but is also quite different from Effexor, too. Effexor hits serotonin at lower doses, and adds an effect on norepinephrine at mid-range doses, adding a mild effect on dopamine at the highest doses. Cymbalta, on the other hand, has a much more balanced profile: it it hits 80% 5HT and 20% NE (I don't know the percentages, just using random numbers) at 20mg, it's gonna have the same breakdown percentages at 120mg. The side effect profile is different, although it will have some crossover with the basic SRI groupings: GI upset, etc. It's really too new to know much about what it will do for weight, but my guess is that it's going to be very much like all the others.
NE tends to be involved with energy, motivation, etc, so it shouldn't be as sedating as some of the SSRIs can be.
I took it for nearly a year and a half, and I can't say I was impressed. That seems to be a pretty common experience, but everyone reacts differently, and I freely admit that I am Treatment Resistant.
Good luck, and I hope this helps.
Posted by Phillipa on January 25, 2006, at 19:35:10
In reply to Re: Cymbalta » Berberis, posted by Racer on January 25, 2006, at 18:36:27
Two experiences and both totally different. The first time a year ago I took up to 60mg and no side effects. A few weeks ago I started on 30mg and couldn't stand the agitation, anxiety, insomnia, leg twitching, sweating at night so the pdoc dc'd it. But both times I experienced a reduction in back pain go figure. It is for periperhal neuropathy in diabetes and I don't have it. Fondly, Phillipa
Posted by yxibow on January 26, 2006, at 12:52:18
In reply to Cymbalta, posted by Berberis on January 25, 2006, at 14:10:31
> Pdoc has suggested I try Cymbalta to replace Wellbutrin. He CLAIMS there's a low side effect profile and no weight gain issue. How is it different from SSRI's (of which I've taken plenty)? If you've taken it, would you share with me your experience?
Not to break semantics but it is an SSNRI. For some, I sympathise, but I have a hard time believing the side effect profiles I see here. I believe them though because I trust how people feel. People are splitting capsules (please dont chew the enteric pulsules in the capsules, you'll get immediate release!) from even 20s.
I have had no weight gain, and few side effects except perhaps some serotonergic zaps when I'm excercising. It is less effective than Luvox for my OCD but more effective for my secondary depression. In fact at 90 mgs now, it may be doing even more. Some studies show no difference at 120 than 60, and this may be statistically true but I see a subtle difference.
It takes a while to really take effect... its one of those you have to hold on for a while. If you couldn't stand Effexor, I'd try Cymbalta. Its a heck of a lot subtler in the background than the prior. For me. Some need the stimulation from Effexor paradoxically for social anxiety disorder, though this seems odd to me, but it works.
As for switching from Wellbutrin -- if you're one who is more depressed than anxious, you'll probably get miles from Cymbalta. If you're more anxious than depressed, and you felt on fire from Wellbutrin, Cymbalta may be more gentler, but you might feel some side effects. Depends.
Hope that helps
Cheers
Jay
Posted by Berberis on January 26, 2006, at 13:50:22
In reply to Re: Cymbalta » Berberis, posted by yxibow on January 26, 2006, at 12:52:18
Thanks Jay. I'm glad to hear you didn't gain weight on it. I think it would be worth a shot for me but I found out today that my insurance won't pay for it and it costs about $3 a pill.
Posted by Berberis on January 26, 2006, at 14:00:26
In reply to Re: Cymbalta » Berberis, posted by Racer on January 25, 2006, at 18:36:27
> Anyway, Cymbalta is part of the same class of drugs as Effexor, but is also quite different from Effexor, too. Effexor hits serotonin at lower doses, and adds an effect on norepinephrine at mid-range doses, adding a mild effect on dopamine at the highest doses. Cymbalta, on the other hand, has a much more balanced profile: it it hits 80% 5HT and 20% NE
What's 5HT and NE?
I'm constantly amazed at the knowledge people here possess. Where do you learn about all this?
Sometimes I wonder if my pdoc is pushing the new drugs because the drug reps are giving him nice *incentives*.
Posted by Racer on January 26, 2006, at 18:28:59
In reply to Re: Cymbalta » Racer, posted by Berberis on January 26, 2006, at 14:00:26
> >
>
> What's 5HT and NE?Hey, stick around and you'll be able to throw these terms around, too. I learned most of this stuff by looking up information in order to understand what people were writing about here.
5HT: 5-hydroxytryptophan, known to its friends as serotonin ;-D
NE: norepinephrine, which is just too long to type over and over again.
What I was trying to say is that Cymbalta is pretty well balanced in its effects on serotonin and norepinephrine, rather than being dose dependent as Effexor is. While the thinking regarding SSRIs is that serotonin -- also too long to keep typing -- is the major player in depression, that probably isn't true for everyone. The older ADs, the TCAs and MAOIs, hit all three of the major monoaminic neurotransmitters, pretty scattershot, not a lot of selectivity. And they worked. The MAOIs are the most powerful, in that they just plain hit all three like a ton of bricks. And the MAOIs are often said to be the most reliable ADs, the ones that don't poop out, the ones that stay pretty consistent.
If you've been on drugs in the past that helped, that can often give clues about what will work in the future. And the mechanism of the drug will also offer clues about the side effect profile, too. For instance, NE is related to the whole adrenal system, so drugs that target it are more likely to trigger anxiety. 5HT is most active in the digestive system, so those drugs will generally have adverse GI effects and then weight gain during later stages of treatment.
Does that help?
Where do you learn about all this?
>
> Sometimes I wonder if my pdoc is pushing the new drugs because the drug reps are giving him nice *incentives*.Nope. Trust me -- all those pens and paper pads? The lunches? They don't have much effect at all. In fact, if you've ever worked in an environment where you get those pens, etc, they tend to be annoying. And the lunches, at least in my non-medical experience of company reps taking us to lunch to hype their products, are laughable.
I think the reason that doctors get excited about new drugs is twofold: 1, they want to see what happens. Just plain curiousity, will this work? What side effects will it have? Etc. Secondly, I think doctors get so frustrated by how little they really have to work with. Something new, which just might work better? I'm gonna prescribe it to ALL my suffering patients who haven't been helped so far. Make sense?
Hope my thoughts have been helpful.
Posted by Karla on January 26, 2006, at 23:17:25
In reply to Re: Cymbalta » Berberis, posted by Racer on January 25, 2006, at 18:36:27
I started taking cymbalta 30mg a few months ago after comming off of years on effexor 300mg. I am not tired on it and have noticed no side effects with this medicine. Its great being awake. No weight gain either. However, I am so mad at my pdoc. She knew what meds I am on and one is fentanyl patch 50mcg for cluster headaches and migraines. This is a strong narcotic. Plus she has me on xanax for anxiety issues. I take imitrix for breakthrough ha. You are not suppose to mix cymbalta with narcotics or imitrix! I found this out like 5 months after the fact. They issue a strong warning on this but everyone reacts differently to the drug. They have to issue the warning to cover their but however I seem to have no interaction issues and am lucky. Please be careful people.
Posted by yxibow on January 27, 2006, at 0:43:38
In reply to Re: Cymbalta » yxibow, posted by Berberis on January 26, 2006, at 13:50:22
> Thanks Jay. I'm glad to hear you didn't gain weight on it. I think it would be worth a shot for me but I found out today that my insurance won't pay for it and it costs about $3 a pill.
I'm not going to ask the insurance carrier, that would violate your confidentiality. A 30 day supply of 60mg Cymbalta is around $109-$120, which you're right, is $3 a pill unfortunately (and any size bottle is about the same, the 20 and 30s are about $10 less). Ask your psychiatrist if he/she has any samples. Some have Lilly connections, which might help on your cost. Unfortunately it is still so new that Costco does not have much more of a discount on it. I'm sorry to hear that.
Posted by Berberis on January 27, 2006, at 10:54:23
In reply to Re: Cymbalta » Berberis, posted by Racer on January 26, 2006, at 18:28:59
As usual, your response was articulate, informative and supportive.
Thanks, Racer.
BTW - I hope you feel better soon.
Posted by paltiel on January 30, 2006, at 21:15:53
In reply to Re: Cymbalta ? Berberis, posted by yxibow on January 27, 2006, at 0:43:38
It's not too difficult to get it from Lilly. Most of the drug companies have started free med programs. Ask your pharmacist for the 800 number for Lilly. You'll have to fill out a 2 page form, but it's usually easy to qualify.
> > Thanks Jay. I'm glad to hear you didn't gain weight on it. I think it would be worth a shot for me but I found out today that my insurance won't pay for it and it costs about $3 a pill.
>
> I'm not going to ask the insurance carrier, that would violate your confidentiality. A 30 day supply of 60mg Cymbalta is around $109-$120, which you're right, is $3 a pill unfortunately (and any size bottle is about the same, the 20 and 30s are about $10 less). Ask your psychiatrist if he/she has any samples. Some have Lilly connections, which might help on your cost. Unfortunately it is still so new that Costco does not have much more of a discount on it. I'm sorry to hear that.
>
>
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.