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Dr. Bob is Robert Hsiung, MD,
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Posted by rosa63 on November 18, 2006, at 9:24:36
I had been taking Cymbalta (60mg) Adderall (10 mg tid). A month ago my pdoc stopped the Adderall and added Provigil (200mg) to the Cymbalta to help increase my energy and to reduce flatness, social withdrawl/isolation, and ADD symptoms.
Provigil has been wonderful for increasing my energy and mental alertness; however, I now have moodswings, agitation, and problems sleeping. It has not helped me with the flatness or social withdrawal issues.
I don't want to give up on Provigil because it gives me so much energy and focus (whereas, before I was letharic all day long). AND, I cannot tolerate any of the amphetamine meds.
What are some ideas or recommendations of some meds I can add to my cocktail to increase my mood, help with sleep, social withdrawal, and flatness?
TIA for any ideas, comments, or suggestions.
Posted by Racer on November 18, 2006, at 13:06:29
In reply to What can I add to Cymbalta and Provigil?, posted by rosa63 on November 18, 2006, at 9:24:36
This is only a guess, and it's worth exactly that, so please don't take it as anything of any real worth, OK? (<< How's that for a disclaimer? Maybe I should be on the Self-Esteem board?)
Social withdrawal is associated with the dopamine system, so I'd think about either adding Wellbutrin or -- and this is probably what I'd consider asking my doctor about if it was an issue for me -- swapping the Cymbalta for a TCA, like desipramine. Or adding Remeron, I suppose. (I had a bad reaction to Remeron, though, so I don't think of that first, even though a lot of other people have responded well to it.)
For what it's worth, Cymbalta left me flat and amotivated. Not depressed, really, just a little hopeless, not caring about much -- although I cared terribly that I wasn't able to care about anything, if that makes sense? It can be an effect of serotinergic drugs for some people. It could be that you're on too high a dose for you, or that it's just not the right drug for you.
Have you tried other drugs? Did any of them help the social withdrawal or flatness? Are those features of your depression, in general? And did anything else you've tried make it worse? All those things can help figure out what would help you now.
Good luck.
Posted by rosa63 on November 18, 2006, at 14:14:42
In reply to Re: What can I add to Cymbalta and Provigil? » rosa63, posted by Racer on November 18, 2006, at 13:06:29
> This is only a guess, and it's worth exactly that, so please don't take it as anything of any real worth, OK? (<< How's that for a disclaimer? Maybe I should be on the Self-Esteem board?)
>
> Social withdrawal is associated with the dopamine system, so I'd think about either adding Wellbutrin or -- and this is probably what I'd consider asking my doctor about if it was an issue for me -- swapping the Cymbalta for a TCA, like desipramine. Or adding Remeron, I suppose. (I had a bad reaction to Remeron, though, so I don't think of that first, even though a lot of other people have responded well to it.)
>
> For what it's worth, Cymbalta left me flat and amotivated. Not depressed, really, just a little hopeless, not caring about much -- although I cared terribly that I wasn't able to care about anything, if that makes sense? It can be an effect of serotinergic drugs for some people. It could be that you're on too high a dose for you, or that it's just not the right drug for you.
>
> Have you tried other drugs? Did any of them help the social withdrawal or flatness? Are those features of your depression, in general? And did anything else you've tried make it worse? All those things can help figure out what would help you now.
>
> Good luck.Thank you for your advice and NOOOO you don't need to go on the self-esteem board! lol
I took Wellbutrin for two years and then I was off of it for about two years. I have tried three times to get back on it and I am now allergic to it???? I get itchy, rashes all over my body. I wish I could get back on Wellbutrin, as that was the only AD that has ever been effective for me.
I have tried all the SSRI's (except Luvox) and the SSNRI's. I have been relunctant to try Remeron because of the weight gain and excess sleep associated with it? At this point, I would prefer to be fat and happy than thin and depressed. I may just reconsider Remeron.
I have "just gotten by" on all my meds for so long. Now, I am ready to make whatever med changes are required to live a happy, productive life!
Posted by Lindenblüte on November 18, 2006, at 16:26:18
In reply to What can I add to Cymbalta and Provigil?, posted by rosa63 on November 18, 2006, at 9:24:36
> I had been taking Cymbalta (60mg) Adderall (10 mg tid). A month ago my pdoc stopped the Adderall and added Provigil (200mg) to the Cymbalta to help increase my energy and to reduce flatness, social withdrawl/isolation, and ADD symptoms.
>
> Provigil has been wonderful for increasing my energy and mental alertness; however, I now have moodswings, agitation, and problems sleeping. It has not helped me with the flatness or social withdrawal issues.>
> I don't want to give up on Provigil because it gives me so much energy and focus (whereas, before I was letharic all day long). AND, I cannot tolerate any of the amphetamine meds.
>
> What are some ideas or recommendations of some meds I can add to my cocktail to increase my mood, help with sleep, social withdrawal, and flatness?
>
> TIA for any ideas, comments, or suggestions.I take cymbalta 120 mg and provigil 200mg and also seroquel 300mg for depression and dare I say depersonalization?
Moodswings are much less too. The seroquel was incredibly sedating for about 2 weeks, but then I got used to it, and now I can actually wake up on my own, pop my provigil and the day begins (more or less). When I was only taking 25 mg seroquel to help me sleep, I did not notice any benefit to my mood swings.
The reason why we increased my seroquel is because I had a lot of intrusive thoughts of bad things (memories, or foreshadowing). I am not sure what the effects would be on flatness or social withdrawal.
I find it interesting that you have moodswings, agitation, and flatness. Are there circadian patterns? precursors to a change of mood in terms of your envirnoment or nutrition?
best of luck to you,
stable, happyish,
-Li
Posted by rosa63 on November 18, 2006, at 16:37:28
In reply to Re: What can I add to Cymbalta and Provigil? » rosa63, posted by Lindenblüte on November 18, 2006, at 16:26:18
> I find it interesting that you have moodswings, agitation, and flatness. Are there circadian patterns? precursors to a change of mood in terms of your envirnoment or nutrition?
Not at all. The 'ick' mood (not necessarily moodswings) and agitation only began after I started the Provigil. The flatness has been prevalent for a years. I just have not addressed that issue until now.
Thank you for sharing your experience with Seroquel! Have you gained a lot of weight with it? I really hate to find something that is going to cause me to gain weight because my cravings for sweets have already been greatly increased since I began Cymbalta.
Posted by rosa63 on November 18, 2006, at 16:45:26
In reply to Re: What can I add to Cymbalta and Provigil? » rosa63, posted by Lindenblüte on November 18, 2006, at 16:26:18
What would be the possible outcome if I added Geodon?
Posted by lymom3 on November 18, 2006, at 17:04:15
In reply to Re: What can I add to Cymbalta and Provigil? » rosa63, posted by Lindenblüte on November 18, 2006, at 16:26:18
I will also say that for me Cymbalta was just horrible. I slept all the time and could hardly pry myself out of bed let alone out of the house. Seroquel or Geodon sound reasonable to me.
Posted by zeugma on November 18, 2006, at 19:06:51
In reply to What can I add to Cymbalta and Provigil?, posted by rosa63 on November 18, 2006, at 9:24:36
It has not helped me with the flatness or social withdrawal issues.>>
provigil is an 'introverting' drug, for me at least.
I think it's a serotonergetic effect.
-z
Posted by rosa63 on November 19, 2006, at 0:24:26
In reply to Re: What can I add to Cymbalta and Provigil? » rosa63, posted by zeugma on November 18, 2006, at 19:06:51
> It has not helped me with the flatness or social withdrawal issues.>>
>
> provigil is an 'introverting' drug, for me at least.
>
> I think it's a serotonergetic effect.UGGGG!!! I think next time I need to just be blunt with my pdoc and her to PLEASE stop all the meds that are making me more introverted!?!?
Posted by Lindenblüte on November 19, 2006, at 8:17:30
In reply to Re: What can I add to Cymbalta and Provigil?, posted by rosa63 on November 18, 2006, at 16:37:28
Hi Rosa,
I gained about 8 pounds in a month when I started the higher dose of seroquel. Like the fatigue, however, the carb cravings are gradually fading.I have lost 3 pounds in the last 2 weeks by following the suggestions of " You on a diet". Specifically, I eat a fiber-rich breakfast every morning, and try to eat a small snack of nuts and dried fruit when I notice my blood sugar dropping. I added a little bit more activity (walking) and stopped eating refined sugars and carbohydrates. (well, okay-- I had a cupcake!) The interesting thing, though is that when I ate the cupcake I felt like total crap after half an hour. lethargic, sick, queasy.
The most important thing is to listen to your body. Eat healthy for 2 days, and I wonder whether you will have as many cravings for sugar.
I'm sorry Provigil is giving you the "ick" mood. Sounds unpleasant.
best,
-Li
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