![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Robert35 on May 21, 2006, at 17:09:49
Hi all,
Currently I am on Cymbalta and tramadol ("Ultram") for painproblems and depression.
I have had a lot of trouble with the Prozac I was on till about 10 weeks ago: trouble concentrating (at my job; at home not being able to read), emotionally feeling flat (like I am "ok" with almost everything), feeling exhausted, not adequately reacting e.g. at my job or too slow to react, sexual trouble.
(It would take (and still does) me 80 minutes to write this.)
For those reasons I wanted to try another (combination of) other medicines.
I went to my gp and because I know he doesn't know much about these meds I brought a list of possible medicines to try.
First choice on my list was Parnate (but that is hardly ever subsribed here in the Netherlands and then only with a special permission for the doc); the doctor not even answered my question to prescribe this med.
Then desimpramine (not available since 2002 anymore here) and cymbalta.
He was ok on prescribing me cymbalta.I am now on day 26 of using this and feel horrible: I feel weak and awfull, still nauseous, still have much trouble to concentrate (and no sexual feelings whatsoever).
Though I go to my job every day, in my free time
I don't get myself to do anything (except sleeping too much), no exercise (like I (try to) do normally).
Compared to Prozac I think I would rather go back to Prozac after 6 weeks (the time I give myself to try cymbalta); Prozac is activating (to the point of not sitting still when I have to) and not making me nauseous/weak/wanting to sleep and stay at home.
Another choice would be to try imipramine as I have heard many positive things about this med but this maybe just incidental information ( http://askapatient.com/viewrating.asp?drug=81048&name=IMIPRAMINE% ).Can anyone compare imipramine to Cymbalta ?
Is imipramine more activating than Cymbalta ?
Would it be possible to get used to side effects like orthostatic hypotension.
Does it give a "mental fog" (compared to ssri's or snri's) ?
Sexual problems ?
I am a bit at the end of my rope (except for my collegues I see everyday and a friend with whom I chat I haven't seen friends (or family) or haven't gone out from December last year).
I am concerned that when I would try yet another medicine and it might not be right for me I could get in trouble at my job and lose it.
Therefor at times going back to Prozac seems like a safer bet.
Thanks for listening and/or responding, wishing well for you ,Robert
Posted by linkadge on May 21, 2006, at 17:31:43
In reply to Cymbalta vs imipramine, posted by Robert35 on May 21, 2006, at 17:09:49
Imipramine is probably a superior antidepressant. Cognitive problems on imipramine may occur, but one may be able to counteract them with other drugs.
Some people do well on a combination of prozac, and a TCA like nortryptaline.
Linkadge
Posted by Phillipa on May 21, 2006, at 21:49:04
In reply to Re: Cymbalta vs imipramine, posted by linkadge on May 21, 2006, at 17:31:43
Thanks Link for stepping in you're really needed tonight. Love Phillipa
Posted by linkadge on May 21, 2006, at 21:50:52
In reply to Re: Cymbalta vs imipramine » linkadge, posted by Phillipa on May 21, 2006, at 21:49:04
What do you mean?
Linkadge
Posted by Phillipa on May 21, 2006, at 22:26:15
In reply to Re: Cymbalta vs imipramine » linkadge, posted by Phillipa on May 21, 2006, at 21:49:04
No ones here with the knowlege you have. Love Phillipa maybe earlier they were but not now
Posted by ed_uk on May 22, 2006, at 13:05:10
In reply to Cymbalta vs imipramine, posted by Robert35 on May 21, 2006, at 17:09:49
Hi Robert
Do you have a list of the antidepressants available in the Netherlands? It would be very helpful.
Ed
Posted by Robert35 on May 22, 2006, at 16:10:50
In reply to Re: Cymbalta vs imipramine » Robert35, posted by ed_uk on May 22, 2006, at 13:05:10
Hello Linkadge, Philippa, Ed_Uk,
Thanks for thinking with me.
Linkadge: maybe more a question for a doctor but which drugs can couteract cognitive problems on imipramine ?
B.t.w. I have read that imipramine can especially do good (because of the action on norepinephrine) for concentration and motivation (it is used sometimes for adhd).
Also imipramine seems do work on more brain chemicals (for lack of a better word) like ACTH (which Cymbalta doesn't).I have the idea that doctors in the Netherlands are not really fond of or specialized enough to augment e.g. a tca with prozac or ad's with stimulants; though of course ad's together with a anxioletic or neuroleptic are prescribed.
At least I don't know of a doctor who might do this.
My gp says I have to find one myself ("use the phone directory" .. then he is willing to refer me).
(I was under the impression that he might ask around among collegues but apparently I am wrong.
Though sceptic about it I still could do some research on internet to get to know a good specialist who is willing to take me as a patient.)Ed_uk: a list would rather be an exclusive list because most ad's are available, unfortunately not the most interesting like desipramine, reboxetine and tianeptine.
Wellbutrin is available as Zyban (not registered as a.d.) and is not covered by insurance when used as an antidepressant.
Zyban I cannot use together with tramadol and an ad (because of risk of seizures).
To my knowledge all other tca's are available in the Netherlands (I have to look it up tomorrow when I have more time).
Maoi's: Nardil and Parnate are available but only after permission for the doctor (about Marplan I am not sure).
I have tried Aurorix to no avail.
Trazodon, Celexa, Zoloft, Seroxat, Effexor, fluvoxamine (Luvox), amytriptiline I have used in the past as well.
Of all these Prozac did at least something and was tolerable for me (regarding immediate side-effects (I could do my job with it)).As it is getting late I will look up more in detail if there are medicines not available here but I think I pretty much summed them all up ;).
For now: the best to you ,
cheers,Robert
Posted by ed_uk on May 23, 2006, at 15:53:18
In reply to Re: Cymbalta vs imipramine, posted by Robert35 on May 22, 2006, at 16:10:50
Hi
>desipramine, reboxetine
I think nortriptyline is available though. As far as I know, the brand name in the Netherlands is Nortrilen. Nortriptyline is quite similar to desipramine but occasionally causes drowsiness at first and it often given as a single dose in the evening. Nortriptyline is predominantly an NE reuptake inhibitor.
>Wellbutrin is available as Zyban (not registered as a.d.
Just like the UK. I think it's the same all over Europe.
Posted by linkadge on May 23, 2006, at 16:12:42
In reply to Re: Cymbalta vs imipramine, posted by Robert35 on May 22, 2006, at 16:10:50
Imipramine has fairly strong anticholinergic effects. I believe some doctors have used cholinergic enhancing agents to help counteract some of the cognitive side effects.
Aricept may help.
Linkadge
Posted by Robert35 on May 26, 2006, at 7:03:54
In reply to Re: Cymbalta vs imipramine » Robert35, posted by ed_uk on May 23, 2006, at 15:53:18
> I think nortriptyline is available though. As far as I know, the brand name in the Netherlands is Nortrilen.
Thanks Ed,
Yep ... you are right.
It might like Linkadge suggested in his mail before his last one be a good augmentation for Prozac: Prozac in the morning and Nortrilen in the evening before going to bed.
I want to discuss this with my pain doc next time I see him, but it seems to me Nortrilen will be a good agent against pain too (being a nor-epinephrine uptake inhibitor).B.t.w. I started Prozac again yesterday (and stopped Cymbalta).
I had so much trouble at my job: feeling gloomy (a very un-Prozac like state-of-mind for me), nauseous, weak and paranoid (suspecting nasty motives from my boss and my manager and expecting bad things to happen which could turn out to become true because I had trouble functioning) that I finally threw the towel in the ring.
Yesterday after taking P. I felt already better: it appears as though the stimulant properties of Prozac help me quite a bit for some time (and maybe the anti-depressant effect does too (noticeable after 2 or 3 weeks)).(In the first instance before posting here I had been thinking of imipramine (and of desipramine before) because it is one of the most appreciated a.d.s (that is ... according to askapatient.com).
Those are not rules of course; like many on this board already said "everyone is different" (many react differently to these a.d. meds .))
Cheers,Robert
Posted by Robert35 on May 26, 2006, at 7:23:09
In reply to Re: Cymbalta vs imipramine, posted by linkadge on May 23, 2006, at 16:12:42
> Imipramine has fairly strong anticholinergic effects. I believe some doctors have used cholinergic enhancing agents to help counteract some of the cognitive side effects.
>
> Aricept may help.
>
> LinkadgeThanks Linkadge,
Actually I was considering imipramine because it has stimulant properties (and that is what I seem to tolerate best) in contrast to amitryptiline(-like meds) and it is in the top of the list of "askapatient.com" (for what that may be worth; the amounts of reactions of patient are not really comparable I think because some meds only have a few reviews of users while others hundreds).
The stimulant properties are why desipramine appealed to me as well.
And nortryptiline less for that matter (but combined with Prozac it would be good I guess (plus it isn't available in the Netherlands anymore)).
If I choose imipramine I will discuss Aricept with my pain doctor (he is a neurologist so he must have knowledge about anti-parkinson meds as well).Have a good day, cheers,
Robert
Posted by circusboy on May 27, 2006, at 21:48:34
In reply to Cymbalta vs imipramine, posted by Robert35 on May 21, 2006, at 17:09:49
> I have had a lot of trouble with the Prozac I was on till about 10 weeks ago: trouble concentrating (at my job; at home not being able to read), emotionally feeling flat (like I am "ok" with almost everything), feeling exhausted, not adequately reacting e.g. at my job or too slow to react, sexual trouble.
> (It would take (and still does) me 80 minutes to write this.)After I'd been on Prozac again for a while (~1 year) I experienced the very same thing. Writing was especially excruciating, as was any sort of task that required sustained attention (following recipes, pushing data around at work). My head was constantly buzzing with incoherent half-thoughts as well, and I was perpetually anxious. This was odd to me, as I'd taken the drug several times before without this happening. At least not to the same degree -- in retrospect, it might've contributed to the circumstances that made me drop out of college. My psychiatrist prescribed Ritalin (methylphenidate), which helped *tremendously*. If you decide to stick with Prozac, I strongly recommend a stimulant (doctor willing, of course).
However, I don't think you should stick with Prozac. Early this year I tapered off Prozac (for, as it turns out, probably specious reasons: I blamed the drug for sexual issues when it was probably just anxiety in a new relationship) and on to, as it were, desipramine. Over the course of several weeks my anxiety almost disappeared and my concentration improved dramatically. I was amazed. Unfortunately, it turned out I couldn't sleep on a theraputic (for me: ~50mg) dose of desipramine and had to stop. I tried nortriptyline next. Couldn't tolerate that, either: I slept very well and my mood was starting to improve, but it caused some serious memory and cognitive disturbances.
I quit antidepressants altogether, and just stuck with Ritalin at 25-30mg/day. *The anxeity and cognitive problems I had on Prozac did not return!* I truly thought it was the desipramine conferring all those benefits, but it turns out a lot of it came just from *stopping Prozac*.
Now, I'm not anti-Prozac. In fact, it was one of only two SSRIs that actually worked for me (the other was sertraline), and I thought I'd be on it for the rest of my life. It had helped me quite a bit in the past. My guess is that Prozac, over the long term, supresses dopamanergic neurotransmission and causes anxeity through direct agonism at the 5HT2C receptor, as well as by simply increasing extracellular serotonin. (Please correct and/or add to my hypothesis if you've got any ideas). This would at least help explain the cognitive issues.
What were/are the primary symptoms of your depression? Not that the dots are easily connected, but it's at least a place to start.
-cb
Posted by ed_uk on May 28, 2006, at 11:36:57
In reply to Re: Cymbalta vs imipramine -------- Linkadge, posted by Robert35 on May 26, 2006, at 7:23:09
Hi Robert
When do you see your doctor? Let us know what you decide :)
Ed
Posted by Robert35 on May 28, 2006, at 16:16:14
In reply to Re: Cymbalta vs imipramine » Robert35, posted by circusboy on May 27, 2006, at 21:48:34
Hi Circusboy,
> .. Writing was especially excruciating, as was > any sort of task that required sustained
> attention (following recipes, pushing data
> around at work). My head was constantly buzzing > with incoherent half-thoughts as well, and I was > perpetually anxious.The way you describe it is even more familiar than I put it in my earlier post... now you guess what does that mean ;) ?
> My psychiatrist prescribed Ritalin
> (methylphenidate), which helped *tremendously*. > If you decide to stick with Prozac, I strongly
> recommend a stimulant (doctor willing, of
> course).
>I didn't do much reading on stimulants and ADD drugs till now (because I suspect they are not easily prescribed anywhere (and Dutch doctors have a reputation to keep to prescribe as little as possible) but I guess it works by augmenting Prozac with a DA (and possibly a nor-epinephrine ) action ?
My plan is to try nortryptiline first (against pain) together with the Prozac and see what it will do (with or without P.); I will do some further reading and keep this in mind (thanks for mentioning!).
If I can convince my pain doc that it is working against pain he is willing to prescribe I guess (he almost solely works with meds).
(I am not seeing a pdoc now.)> However, I don't think you should stick with
> Prozac. Early this year I tapered off Prozac
> (for, as it turns out, probably specious
> reasons: I blamed the drug for sexual issues
> when it was probably just anxiety in a new
> relationship) and on to, as it were,
> desipramine. Over the course of several weeks
> my anxiety almost disappeared and my
> concentration improved dramatically. I was
> amazed. Unfortunately, it turned out I couldn't > sleep on a theraputic (for me: ~50mg) dose of
> desipramine and had to stop. I tried
> nortriptyline next. Couldn't tolerate that,
> either: I slept very well and my mood was
> starting to improve, but it caused some serious > memory and cognitive disturbances.
>
> I quit antidepressants altogether, and just
> stuck with Ritalin at 25-30mg/day. *The anxeity > and cognitive problems I had on Prozac did not
> return!* I truly thought it was the desipramine > conferring all those benefits, but it turns out a > lot of it came just from *stopping Prozac*.
>
> Now, I'm not anti-Prozac. In fact, it was one
> of only two SSRIs that actually worked for me
> (the other was sertraline), and I thought I'd be > on it for the rest of my life. It had helped me > quite a bit in the past. My guess is that
> Prozac, over the long term, supresses
> dopamanergic neurotransmission and causes
> anxeity through direct agonism at the 5HT2C
> receptor, as well as by simply increasing
> extracellular serotonin. (Please correct and/or > add to my hypothesis if you've got any ideas). > This would at least help explain the cognitive
> issues.This would be such a nice solution (just one easy tolerable med.) but is there no habituation to Ritalin (or can it poop out) ?
>
> What were/are the primary symptoms of your depression? Not that the dots are easily connected, but it's at least a place to start.
>
> -cbActually I started a.d's 14 years ago because of excruciating pain I have since 17 years.
I also experienced lots of trouble going to sleep, waking up, trouble concentrating and being easily irritated, not being able to get ahead in my life (I had to make some choices and each attempt failed).
I have had a two depressive episodes in my teens, which were not treated so it is a mixted picture (so to speak).
I have to leave it at this (getting late here), thanks again for your input,
best regards,Robert
Posted by Robert35 on May 28, 2006, at 16:19:56
In reply to Re: Cymbalta vs imipramine -------- Linkadge » Robert35, posted by ed_uk on May 28, 2006, at 11:36:57
> Hi Robert
>
> When do you see your doctor? Let us know what you decide :)
>
> EdHi Ed,
Probably next Friday (it is difficult to skip before that) and I will let you all know what I decide :-) ... (I was thinking about doing that today already).
Cheers,Robert
Posted by Robert35 on May 31, 2006, at 14:51:45
In reply to Re: Cymbalta vs imipramine, posted by linkadge on May 21, 2006, at 17:31:43
> Some people do well on a combination of prozac, and a TCA like nortryptaline.
>
> LinkadgeHi Linkadge,
Do you perhaps know if Prozac counteracts the breakdown of nortryptiline like it does with Pamelor (imipramine) so that low dosing and monitoring bloodlevels are necessary ?
I am afraid my gp doesn't know these things (the pharmacy I go to should know).
Thanks, cheers,Robert
Posted by Robert35 on June 5, 2006, at 11:27:12
In reply to Re: Cymbalta vs imipramine -------- Linkadge » Robert35, posted by ed_uk on May 28, 2006, at 11:36:57
> Hi Robert
>
> When do you see your doctor? Let us know what you decide :)
>
> EdHello Ed and others,
I decided not to go to my doctor last Friday, because I want to wait till the Prozac kicks in (I am in day 12) to see clearly what med causes which effect.
I will let you know when I have talked with him ,
take care, the best to you,Robert35
Posted by Robert35 on July 24, 2006, at 11:25:23
In reply to Re: Cymbalta vs imipramine -------- Linkadge, posted by Robert35 on May 28, 2006, at 16:19:56
Hi Philippa, Linkadge, Ed_uk, Circusboy and others,
I promised an update regarding what we discussed.
Unfortunately by mistake my paindoctor (who could and would change something about my current combo of Prozac + tramadol) was on vacation at the beginning of July.
Instead of going to him I had a choice to go to a collegue of him or consult him on next month August 8 th.
I chose for the latter.
Sorry I didn't let you all know how things would turn out but I haven't been doing well.Good luck/relief to all of you,
Robert35
Posted by KarenRB53 on August 11, 2008, at 14:04:22
In reply to Re: Cymbalta vs imipramine, posted by linkadge on May 21, 2006, at 17:31:43
> Imipramine is probably a superior antidepressant. Cognitive problems on imipramine may occur, but one may be able to counteract them with other drugs.
>
> Some people do well on a combination of prozac, and a TCA like nortryptaline.
>
> LinkadgeSorry, I know this is an old post but hope you read it. I'm in a similiar situation as Robert that you have been posting to and was wondering re: the above post....would you suggest the imipramine or augmenting the prozac with nortriptyline (as I'm still on just Prozac)? Thanks for any suggestions.
Karen
Posted by KarenRB53 on August 11, 2008, at 14:05:02
In reply to Re: Cymbalta vs imipramine, posted by linkadge on May 21, 2006, at 17:31:43
> Imipramine is probably a superior antidepressant. Cognitive problems on imipramine may occur, but one may be able to counteract them with other drugs.
>
> Some people do well on a combination of prozac, and a TCA like nortryptaline.
>
> LinkadgeSorry, I know this is an old post but hope you read it. I'm in a similiar situation as Robert that you have been posting to and was wondering re: the above post....would you suggest the imipramine or augmenting the prozac with nortriptyline (as I'm still on just Prozac)? Thanks for any suggestions.
Karen
Posted by KarenRB53 on October 6, 2008, at 11:05:12
In reply to Re: Cymbalta vs imipramine, posted by linkadge on May 21, 2006, at 17:31:43
> Imipramine is probably a superior antidepressant. Cognitive problems on imipramine may occur, but one may be able to counteract them with other drugs.
>
> Some people do well on a combination of prozac, and a TCA like nortryptaline.
>
> Linkadge
I am going to be starting Imipramine shortly after tapering off Prozac which stopped working after many years. I'm worried about the cognitive problems and you said in above message that meds made be added to counter act those problems. Which meds would you suggest?
Thanks, I know this is an old posting but hoping to hear from you.
Karen
Posted by Robert35 on October 7, 2008, at 5:31:32
In reply to Re: Cymbalta vs imipramine, posted by KarenRB53 on October 6, 2008, at 11:05:12
Hi Karen,
I am sorry that I cannot advice you properly.
When I am considering another drug regimen I try to find as much information as possible via dr Bob's, google, askapatient.com etc.
Linkadge suggested aricept in one of the above posts (but of course you read that already ...).I stopped the combo of Prozac and Nortrilen alltogether as it had too many side effects and it didn't do much against pain.
Currently I am on tramadol and Prozac only; engaging in sports is difficult (and maybe counterproductive) so I just have excercise by hiking (and a bit of biking).
Amytriptiline (and Nortrilen) is sometimes prescribed as a pain medication; I am not sure about imipramine.
My paindoctor also suggested Surmontil; it is not fully understood what this med. does; I preferred trying nortrilen back then (being afraid of Surmontil's side effects).
Are you a painpatient or are you depressed or both ?I have read about good results with imipramine (like link says) for many (for that reason I preferred it above amitryptiline and its derivates.)
Good luck; I hope you do well on the imipramine !
Let us know how you are doing, ok ?
Cheers,Robert
> > Imipramine is probably a superior antidepressant. Cognitive problems on imipramine may occur, but one may be able to counteract them with other drugs.
> >
> > Some people do well on a combination of prozac, and a TCA like nortryptaline.
> >
> > Linkadge
>
>
> I am going to be starting Imipramine shortly after tapering off Prozac which stopped working after many years. I'm worried about the cognitive problems and you said in above message that meds made be added to counter act those problems. Which meds would you suggest?
> Thanks, I know this is an old posting but hoping to hear from you.
> Karen
Posted by KarenRB53 on October 7, 2008, at 8:38:21
In reply to Re: Cymbalta vs imipramine » KarenRB53, posted by Robert35 on October 7, 2008, at 5:31:32
> Hi Karen,
>
> I am sorry that I cannot advice you properly.
> When I am considering another drug regimen I try to find as much information as possible via dr Bob's, google, askapatient.com etc.
> Linkadge suggested aricept in one of the above posts (but of course you read that already ...).
>
> I stopped the combo of Prozac and Nortrilen alltogether as it had too many side effects and it didn't do much against pain.
> Currently I am on tramadol and Prozac only; engaging in sports is difficult (and maybe counterproductive) so I just have excercise by hiking (and a bit of biking).
> Amytriptiline (and Nortrilen) is sometimes prescribed as a pain medication; I am not sure about imipramine.
> My paindoctor also suggested Surmontil; it is not fully understood what this med. does; I preferred trying nortrilen back then (being afraid of Surmontil's side effects).
> Are you a painpatient or are you depressed or both ?
>
> I have read about good results with imipramine (like link says) for many (for that reason I preferred it above amitryptiline and its derivates.)
> Good luck; I hope you do well on the imipramine !
> Let us know how you are doing, ok ?
> Cheers,
>
> Robert
>
> > > Imipramine is probably a superior antidepressant. Cognitive problems on imipramine may occur, but one may be able to counteract them with other drugs.
> > >
> > > Some people do well on a combination of prozac, and a TCA like nortryptaline.
> > >
> > > Linkadge
> >
> >
> > I am going to be starting Imipramine shortly after tapering off Prozac which stopped working after many years. I'm worried about the cognitive problems and you said in above message that meds made be added to counter act those problems. Which meds would you suggest?
> > Thanks, I know this is an old posting but hoping to hear from you.
> > Karen
>
>Hi: Thanks so much for responding. I take the meds for depression. I've been diagnosed with Dysthymia plus Major Depressive episodes. I think they call it Double Depression. Don't quite know what to do. Right now I'm not on anything. I stopped the Prozac 5wks ago but definitely need something. I'm starting to feel the signs of depression (or could be lack of Prozac). I just wish Prozac had continued to work well for me.
Karen
This is the end of the thread.
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