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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by butternut on June 7, 2009, at 13:04:32
Due to some unusally large bruises on Effexor XR 75 mg, my doctor is moving me to Cymbalta. Yesterday I dropped to 37.5mg of Effexor and started 20mg of Cymbalta. I stay on this for 5 days, then stop the effexor altogether while staying at 20mg Cymbalta for two days, then up the Cymbalta to 40mg.
Is this going to suck, or is switching from one SNRI to another not that big a deal?
When tapering off SSRIs (zoloft and lexapro), I was always on a low dose to start with and would break the pill in half for a month or so before stopping altogether. This 5-day taper with Effexor is the quickest taper I've ever done.
It's now the afternoon of day two. Yesterday was fine, but I am now feeling a little lightheaded, but I do have a cold and might have a sinus infection.
Posted by Phillipa on June 7, 2009, at 13:13:03
In reply to What to Expect? Going from Effexor to Cymbalta, posted by butternut on June 7, 2009, at 13:04:32
Does the doc think it's liver enzymes causing the bruising as vita K is in the liver and responsible for blood clotting. I don't see a problem switching over. But why another SNRI? What does the doc say the bruising is from? Phillipa
Posted by garnet71 on June 7, 2009, at 13:16:30
In reply to What to Expect? Going from Effexor to Cymbalta, posted by butternut on June 7, 2009, at 13:04:32
I'm interested too. I never took Cymbalta (took Effexor for a couple years though), but am uncomfortable with some of the dual reuptakes. You can't adjust for the seratonin or norepinephrine separately. I'd take 2 separate drugs, esp. since I've had so many problems with the seratonin targeting drugs, but that's just me. I am curious about Cymbalta though, haven't heard much about it. Can you tell us why your doc chose that one, and what you know about it?
I think those drugs are extremely potent--and something leads me to believe more potent than the older drugs, though they keep saying the second-generation ones are safer. There's people who say once on Effexor, you're on it for life, nmaybe that's all just heresay. I sometimes wonder if I've had a long, protracted withdraw from Effexor that has, though probably only in part, led to chronic anxiety. I doubt it, but it sseems I have 2 types of anxiety...well, that's another issue.
Hope it works out for you. Please let us know how you fare.
Posted by garnet71 on June 7, 2009, at 13:43:20
In reply to What to Expect? Going from Effexor to Cymbalta, posted by butternut on June 7, 2009, at 13:04:32
I did a quick search...although most refer to GI bleeding, I found something interesting:
"Results
There are over 120 MEDLINE-cited peer-reviewed research papers and more than 50000 Web pages devoted to SSRI-related bleeding events.Conclusion
Independently of the brand, use of SSRIs is indeed associated with increased bleeding risk. Although such complications are rare, their frequency is growing, and physicians should be aware of SSRI-induced hemorrhages, especially in patients with hereditary platelet defects, and those treated with antiplatelet agents. Prospective studies are urgently needed to determine whether SSRIs will yield additional bleeding risks when used long term concomitantly with aspirin or clopidogrel.There is also emerging evidence that these side effects of SSRIs are due to blockade of serotonin reuptake in platelets and subsequent platelet dysfunction."
This study was inconclusive, but mentions blood platelet effects:"Conclusions: Our patient demonstrated an idiosyncratic hypersensitivity to the platelet inhibitory effects of venlafaxine. Because venlafaxine is an inhibitor of serotonin uptake by platelets and neurons, this mechanism may contribute to the impact of this drug on platelet function. However, our in vitro studies suggest that this hypothesis is inadequate to explain the observations completely."
These articles barely mention bruising, but I thought they interesting. The 2nd is a power point about adverse affects of drugs. I also having been finding the nursing journals seem to focus on adverse effects of antidepressants; i've found good information in some of them in the past. You might want to look there.
http://www3.interscience.wiley.com/journal/118553543/abstract?CRETRY=1&SRETRY=0
http://www.nursing.theclinics.com/article/PIIS0029646502000695/fulltext#section11
Posted by garnet71 on June 7, 2009, at 13:45:23
In reply to What to Expect? Going from Effexor to Cymbalta, posted by butternut on June 7, 2009, at 13:04:32
..so your bleeding issue could be seratonin related. I obviously don't know, but would read further if I were you, and talk to your doctor about the blood issue. Could be your blood type or maybe genetics that is more affected by seratonin?
Posted by butternut on June 9, 2009, at 15:07:43
In reply to What to Expect? Going from Effexor to Cymbalta, posted by butternut on June 7, 2009, at 13:04:32
Thanks everyone for responding!
The doc put me on the SNRI because I came to him extremely depressed and anxious, 8 weeks postpartum, and he wanted to get me feeling better as fast as possible. I told him that zoloft pooped out on me, lexapro had worked only somewhat in the past, and prozac was not doing much for me. He felt going to a different ssri was going to be a waste of time, so he wanted to start effexor, and said that it usually works quickly. This was definitely the case for me, though I can't say if it was going to continue to help or poop out, as it has only been two months since I started. For what it's worth, I have lost some weight on Effexor, and have had no sexual side affects like with the ssris. Orgasm is maybe a little delayed, but better than before!
He didn't say why he thought I was brusing. I told him I had been taking some vitamins that could be blood-thinning as well as fish oil, and that the brusing got better when I stopped taking them. But he did not think vitamins would be doing that. For some reason he did not think Cymbalta would cause the same problem.
He is a new doc for me (old doc was elderly and had to retire suddenly) and he works in a special place designed to treat people who don't need a hospital but can't wait months to get in with a new psychiatrist.
I am not sure how the switch is going. I am having either a severe sinus infection/headache, a toothache, or a migraine brought on by withdrawl. I am still getting over a recent cold, so it is probably just a sinus infection.
Posted by antigua3 on June 12, 2009, at 7:16:04
In reply to Re: What to Expect? Going from Effexor to Cymbalta, posted by butternut on June 9, 2009, at 15:07:43
I switched from Effexor at 300 mg to Cymbalta (can't remember the dose) with no problem. I kept cutting down on the amount of Effexor while increasing the Cymbalta, per my pdoc. I didn't notice any side effects really. I credit my pdoc with doing a good job with it.
I quit the Effexor because I was at such a high dose and it wasn't touching a new round of depression that hit. I was on Cymbalta for maybe three years, and I liked it a lot better. It made me feel less like a zombie.
Last fall the Cymbalta started making me feel so anxious and I thought I was well enough to go off of it. My pdoc had me taper and it was OK.
Just to add, why is it that we always want to go off the drugs when we think we feel better???? My depression came roaring back after 5 months or so, probably long enough for the Cymbalta to really get out of my system, and I caved and went on Celexa, which I like even better than Cymbalta.
Just my two cents,
antigua
Posted by floatingbridge on June 13, 2009, at 21:14:54
In reply to Re: What to Expect? Going from Effexor to Cymbalta » butternut, posted by antigua3 on June 12, 2009, at 7:16:04
Hey, I'll have to remember Antigua's taper if I ever come off pristiq. Effexor withdrawal kicked my butt, and the few times I've missed a pristiq dose, I could feel that awful sensation returning. Thanks for sharing this info!
Posted by floatingbridge on June 13, 2009, at 21:17:59
In reply to Re: What to Expect? Going from Effexor to Cymbalt, posted by floatingbridge on June 13, 2009, at 21:14:54
I forgot to ask you, Butternut, how is the withdrawal going for you?
Posted by butternut on June 19, 2009, at 22:46:58
In reply to Re: Going from Effexor to Cymbalt: How's it going?, posted by floatingbridge on June 13, 2009, at 21:17:59
> I forgot to ask you, Butternut, how is the withdrawal going for you?
Hi, thanks for asking, it went just fine! I was so relieved as there was some really scary stuff out there on the withdrawal. I think it went so well because I switched to a similar med and not off meds altogether.
With Cymbalta, did you get any episodes of racing heart and/or palpitations? I seem to be having this issue at night, most nights, for 10-20 minutes at a time, and I did have it with the Effexor too. It might be linked to eating sweets, but I am not sure.
Posted by floatingbridge on June 20, 2009, at 11:20:53
In reply to Re: Going from Effexor to Cymbalt: How's it going?, posted by butternut on June 19, 2009, at 22:46:58
Oh, good--glad to hear this! I haven't tried Cymbalta, and I can't remember that far back for Effexor. I have experienced what you described when I've eaten sweets or carbo-dense food before bed....
Hope Cymbalta is good to you!
> > I forgot to ask you, Butternut, how is the withdrawal going for you?
>
> Hi, thanks for asking, it went just fine! I was so relieved as there was some really scary stuff out there on the withdrawal. I think it went so well because I switched to a similar med and not off meds altogether.
>
> With Cymbalta, did you get any episodes of racing heart and/or palpitations? I seem to be having this issue at night, most nights, for 10-20 minutes at a time, and I did have it with the Effexor too. It might be linked to eating sweets, but I am not sure.
Posted by butternut on February 17, 2011, at 15:55:50
In reply to Re: Going from Effexor to Cymbalt: How's it going? » butternut, posted by floatingbridge on June 20, 2009, at 11:20:53
A very late update from me! Had no problems with the switch, but cymbalta was not good to me. Within a week, my appetite was raging and I had lost all the motivation for exercise and healthy eating that I had with effexor. After six months or so I had episodes of heart palpitations that nearly made me faint--I thought I was dying. Despite a lifetime of MAJOR panic attacks, i have never felt anything like it. I went off and started taking lexapro again. It's ok. I am not walking around crying or terrified, so I guess it is working somewhat. I have gained tons of weight and I am always tired. Exactly why I went off it in the first place. So... there's my update.
Posted by floatingbridge on February 21, 2011, at 14:40:02
In reply to Re: Going from Effexor to Cymbalt: How's it going?, posted by butternut on February 17, 2011, at 15:55:50
Butternut,
There are a few threads going on right now about folks who discontinued for some reason with negative results. Did you and your doc decide for some reason to avoid another snri like effexor? (Lexapro is a ssri, right?)
Your post is a blast from the past--I think I had been here at PB for about three months :) Ahhh. TRD.
I just aborted Cymbalta due to GI issues---I couldn't eat! Awful. Now I'm tapered
and off and in limbo.How can I say, in a positive way, welcome back?
Thank you for the update. I wish the news were more positive, and I'm sending you some good thoughts your way.
fb
Posted by Elanor Roosevelt on February 28, 2011, at 11:51:03
In reply to Re: Going from Effexor to Cymbalt: How's it going?, posted by butternut on February 17, 2011, at 15:55:50
Are you taking the Lexapro only?
Posted by butternut on March 2, 2011, at 15:03:44
In reply to Re: Going from Effexor to Cymbalt: How's it going?, posted by Elanor Roosevelt on February 28, 2011, at 11:51:03
Thanks for the welcome back floatingbridge! I like to check in every year or so to see what meds are popular and how they are working for people. I'm sorry Cymbalta didn't work for you either. I have sort of given up on hopes of a cure for depression right now, and have settled for the fact that Lexapro at least keeps my panic disorder and severe depression in check. I can function, but just barely. I have a problem with being dead tired ALL of the time, and that just never seems to change even if my mood changes. So I don't know if it's more physical than mental, maybe I am just overweight which I have read will cause fatigue even if you don't have any other problems.
I have read a lot of things on the Web about cymbalta having a lot of side effects. My stepmother was on it briefly and it caused some kind of heart problems for her, although she already had a mild pre-existing heart condition. Effexor was harsh-- made me a little wired, and I sweated all the time--but it actually worked very well. I kind of wish I were still on it, but I had so much bruising while I was on it the doc took me off it. I am kind of scared off the SNRIs now.
To the poster who asked what else I am on--the answer is only lexapro. That and a lot of vitamins. A few years ago I found that I was severly Vit D deficient. Unfortunately I've let myself get there again. I am awaiting results of some new bloodwork to check for thyroid,anemia,mono and some other things to see why the fatigue has recently increased and my period has lengthened.
Sometimes I still wonder if I should be on a mood stabilizer, even though I don't have manic episodes, just severe anxiety and depression. I was at my happiest with a regular daily dose of Zoloft and Klonopin (a tranquilizer that some doctors believe has mood stabilizing properties).
This is the end of the thread.
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