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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by bleauberry on July 14, 2008, at 16:03:26
Ok, anyone who knows me knows that most meds will make me more depressed. ECT did not work either. But one med actually did help a little bit, which was a miracle for any med to do with me, but the other effects it has on me are devastating. So I need advice on those.
The med is Milnacipran. Starts to kick in by day 2 or 3, then it kind of backtracks a bit and doesn't do much else that I can feel. But I know it does. Evidence...at the 2 week mark I was actually enjoying playing my guitar for hours. Didn't enjoy anything else. But at least it was a start, yeah? And that was at just 8mg three times a day, when the starting dose is supposed to be 25mg once or twice a day and then quickly go up to a total of 50mg to 100mg a day.
At my small dose, three major problems:
Lack of appetite: I'm already grossly underweight. Very risky business to lose more. I lost 3 pounds in 2 weeks eating as much as I could, but eating was not enjoyable at all. It was actually hard to eat.
Urinary stoppage/hesitancy/urgency: Severe. Pretty sure it is the norepinephrine at the alpah-1 receptors, because it begins within hours of the first dose.
Aggravation of DeGuerveins Tendonitis (the tendon running up the side of the thumb from the wrist). This has been 100% healed since surgery 10 years ago, but comes back within a day or two of starting Milancipran. Again, I suspect it is the norepinephrine that causes constriction of things.
So what do I do? Not currently on it anymore. One week off it was actually pretty smooth. Thought maybe it had reset some stuff. Not. Rapdily spiraling down again. The worst part is that aweful morning bizarre craziness/anxiety stuff that greets me right out of bed. Milnacipran had completely shut that down.
Flomax...the manufacturer suggests it for the urinary side effects. It blocks alpha-1 receptors and it relaxes arteries and veins, (and maybe muscles and tendons?)
Don't know what to do. I suspect if I could get these side effects under control and get to a higher dose I would be on a road to a better place. Nausea. Too much alpha-1 stimulation. Those are tough to figure out. Is there a safe medication to take that stimulates appetite without other side effects, mechanisms, or risks?
Does anyone know if the excess alpha-1 stimulation would subside over time? Something you could wait it out? Or does it just stay that way?
Thanks all!
Posted by Phillipa on July 14, 2008, at 16:38:26
In reply to Need Some Input, posted by bleauberry on July 14, 2008, at 16:03:26
Ah blueaberry that holistic doc didn't help. And you Know I'm not a med expert are you able to work? Taking any supplements with it? Maybe one of them? Love Phillipa
Posted by Mike_Cohen_2 on July 14, 2008, at 17:24:33
In reply to Need Some Input, posted by bleauberry on July 14, 2008, at 16:03:26
Bleuberry, I first have a question for you. Milnacipran affects two neurotransmitters, norepinephrine and serotonin, almost equally (a 3:1 norepinephrine to serotonin balance). In contrast a SNRI, tends to act much more on serotonin than norepinephrine, (Effexor has a 1:30 norepinephrine to serotonin ratio).
On the other hand, Nortriptyline, and Protriptyline, tend to enhance NE over 5HT at 3:1, 3:2 just as Milnacipran does, Nortriptyline being the more equal.
So my question is, have you tried Nortriptyline, if so, what were your results?
Secondly, I saw the dysuria is common when taking Milnacipran, so not sure if that goes away over time or not. Can't answer the one on the Tendon problem, I don't see a cause/effect there. Lastly, I know all about lack of appetite and weight loss too well. For me, it was a good thing. I lost 20 lbs from 210 down to 190 being 5'10" lol. My only suggestion would be to eat foods high in calories and force yourself to eat. I would think if your depression improves, so would your appetite.
BTW, I didn't understand you post back to me. I understood the part about not taking Buspar, etc. , But were you saying maybe Effexor or Cymbalta would help me due to the downregulation ?
Gary
Posted by Mike_Cohen_2 on July 14, 2008, at 17:30:26
In reply to Need Some Input, posted by bleauberry on July 14, 2008, at 16:03:26
Depending on your response to my question, I might give Nortriptaline a shot myself. Like you said, it appears that Serotonin is not my problem. Please give me more clarification of your thoughts back in my thread. Thanks in advance....
Gary
Posted by atmlady on July 14, 2008, at 21:00:26
In reply to Need Some Input, posted by bleauberry on July 14, 2008, at 16:03:26
Bleauberry, have you tried Lexapro? Lexapro made my heart sing, but I could not put up with the weight gain and anorgasmia. But if you're looking to improve your appetite, Lexapro ought to do it. My GP says she prescribes it to all her underweight little old ladies with great success.
As for the Flomax + milnacipran, sounds like it could work. I was going to point you to a fibromyalgia forum where perhaps some men had commented on what worked for them, but I had no luck finding one. You may be charting new territory here....
Posted by raisinb on July 14, 2008, at 23:33:39
In reply to Need Some Input, posted by bleauberry on July 14, 2008, at 16:03:26
There's a med called--I think--odansetron? that they can give you for nausea. I took it when I had a concussion. Flomax will probably help urinary symptoms, as will drinking a lot of water.
My experience was that loss of appetite is hard to counteract. When I was on Wellbutrin, I literally forced myself to eat as much as possible three times a day, and still lost weight. It wasn't physically possible for me to eat as much when I was forcing down food, as when I got hungry. Because of that and insomnia, I had to add Zoloft.
Posted by Sky Brite Line on July 14, 2008, at 23:50:47
In reply to Re: Need Some Input » bleauberry, posted by raisinb on July 14, 2008, at 23:33:39
Have you had anything other checked......like liver, thats causing this. I hope nothing with the body itsself, or other organs that can cause maybe this.
Sky
Posted by atmlady on July 18, 2008, at 7:42:35
In reply to Need Some Input, posted by bleauberry on July 14, 2008, at 16:03:26
Hey, Bleauberry - I was doing some research on strattera last night, and came across a forum where several men had posted to say the drug gave them problems with urinating, and several of them took Flomax to help with that, so there you go! I hope it'll work for you so you can take the ixel you like so much! Good luck!!!!
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