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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Frustratedmama on April 8, 2010, at 11:50:06
Ok so the cymbalta is really helping but I am soooo faitgued..(actually need a nap so having to take time off from work to sleep)...I already take adderall but thats not enough..any ideas?
Posted by Phillipa on April 8, 2010, at 12:41:18
In reply to How to combat fatigue side effect......, posted by Frustratedmama on April 8, 2010, at 11:50:06
Refute the above thread comment on it as the opposite for me. If above is true you would feel great with no sleep? I personally don't believe it's true. Now to your question I slept on cymbalta but was on benzos. Phillipa
Posted by tensor on April 9, 2010, at 12:41:28
In reply to How to combat fatigue side effect......, posted by Frustratedmama on April 8, 2010, at 11:50:06
> Ok so the cymbalta is really helping but I am soooo faitgued..(actually need a nap so having to take time off from work to sleep)...I already take adderall but thats not enough..any ideas?
Have you tried modafinil? I don't know if it's available where you live, but if your depression/anxiety is under control, it can be very effective.
/Mattias
Posted by morganator on April 9, 2010, at 13:03:34
In reply to Re: How to combat fatigue side effect...... » Frustratedmama, posted by tensor on April 9, 2010, at 12:41:28
I agree Modanafil may be a good choice.
How long have you been on Cymbalta? Maybe the fatigue will pass with time. Or maybe a dosage adjustment will take care of the fatigue and you will feel even better than you do on the current dose.
Posted by Frustratedmama on April 9, 2010, at 18:04:30
In reply to Re: How to combat fatigue side effect......, posted by morganator on April 9, 2010, at 13:03:34
Been on cymbalta a few weeks- Is modafinil the same thing as provigil?
Posted by morganator on April 9, 2010, at 18:08:43
In reply to Modafinil?..... » morganator, posted by Frustratedmama on April 9, 2010, at 18:04:30
Yeah it is.
Well it's only a few weeks in so hopefully you begin to feel better over the next few weeks.
Posted by Frustratedmama on April 9, 2010, at 18:17:30
In reply to Re: Modafinil?....., posted by morganator on April 9, 2010, at 18:08:43
I took it quite a while ago...(been a LONG time) and found it to be less helpful than the stimulants. May need the vyvanse back- just switched from vyvanse to adderall as I was having difficulty sleeping with pristiq and adderall; however, cymbalta seems to have me sleeping more.....so maybe a switch back to vyvanse would work? Not really sure.....
Posted by Phillipa on April 9, 2010, at 20:36:30
In reply to Re: Modafinil?..... » morganator, posted by Frustratedmama on April 9, 2010, at 18:17:30
Worth a try? Love Phillipa
Posted by bleauberry on April 10, 2010, at 14:21:13
In reply to How to combat fatigue side effect......, posted by Frustratedmama on April 8, 2010, at 11:50:06
> Ok so the cymbalta is really helping but I am soooo faitgued..(actually need a nap so having to take time off from work to sleep)...I already take adderall but thats not enough..any ideas?
Time.
And reduce adderall with the goal of eliminating it completely.
I know that sounds weird.
First of all, cymbalta is still new for you. You will not know if fatigue is a concern or not until you've been on it for at least 3 months. It is too early right now.
Second of all, purely a guess but with good reasoning behind it, you've probably already got burned out adrenal glands and the last thing you want to do is stress them even more. Stimulants aren't doing you any favors, despite short term help in symptoms...and well, at this point, not even that.
When people embark on treatment to heal fatigued adrenals, what is a common symptom they feel in the first months? Fatigue. Yep. When healing begins, fatigue is a clue that shows that. The cymbalta could actually be helping you with its tiny amount of NE action. As the adrenals relax a little now that they have a little bit of assistance, fatigue is obvious. As they recover over months, the fatigue will go away. That's the pattern anyway, if this scenario is correct.
The enemy in all this is the one you actually think is your friend...the stimulant, any of them.
The choices of foods you make at the grocery store are critical. I won't go into that, just to say it is a big issue in fatigue that needs to be taken seriously.
Posted by Frustratedmama on April 10, 2010, at 14:27:16
In reply to Re: How to combat fatigue side effect......, posted by bleauberry on April 10, 2010, at 14:21:13
Hey bb
Thanks! I am more than willing to eliminate the stimulant- if it is helpful- and that is easy to try and do.....no withdrawals except faitigue and difficulty with adhd symptoms but I am already tired and spent a great deal of my life without stimulants with adhd...so know how to deal with those symptoms. You really think this will work? I am pretty confident in my food choices as I eat healthy- avoid bad carbs and make sure to balance my protein at each meal time. But suggestions are welcome!
Posted by bleauberry on April 12, 2010, at 18:07:56
In reply to Re: How to combat fatigue side effect...... » bleauberry, posted by Frustratedmama on April 10, 2010, at 14:27:16
> Hey bb
> Thanks! I am more than willing to eliminate the stimulant- if it is helpful- and that is easy to try and do.....no withdrawals except faitigue and difficulty with adhd symptoms but I am already tired and spent a great deal of my life without stimulants with adhd...so know how to deal with those symptoms. You really think this will work?I don't usually mention something unless I have a fair amount of confidence in it. Obviously no guarantees in anything however. I wish one of us here at this board had all the answers, but none of us do and our doctors don't either. We have to go on what our observations and experiences tell us.
I see this a bit differently than you do. It won't be easy. In the early going, your symptoms will get worse. You will feel like you can barely function without the crutch of a stimulant. That's not a bad thing, though it feels real bad. This might drag on for weeks and even a couple months. It isn't something that can just be quickly tried. It is an endeavor with a strategy, a goal line, and expected troubles on the journey back to better health.
It might be worthwhile to add some supplements to your diet that are friendly to your symptoms and to healing the things that might be causing them. Specifically I'm thinking tyrosine, dlpa, and adrenal cortex extracts. Any or all in very low doses and without any expectations of miracles. They aren't fast acting miracles. Whatever the dose is on the bottle, take 1/4 of it. Don't increase it until you've been on it for a couple weeks.
Ever had a thorough thyroid workup? Free t3, t4, reverse t, and the antibodies? If not, it's a good idea just to see.
>I am pretty confident in my food choices as I eat healthy- avoid bad carbs and make sure to balance my protein at each meal time. But suggestions are welcome!
Tons of raw veggies, that one is key.
Anyway, I've never known anyone who got longterm help from stimulants. Whether they are used on the street or prescribed by a doctor, they do the same thing, and the end result after months or years is usually not favorable. Stimulants are kind of like taking out a loan that has to be paid back with interest and penalties in the future. Certainly there are a minority of people who have relied on stimulants for a long time and they function well with them, but I do not believe that is most people. The use of memantine seems to have some potential in keeping stimulants our friends.
Talk about all your feelings and thoughts with your doctor. I think it is important to have a wide open respectful relationship.
Posted by Frustratedmama on April 12, 2010, at 19:03:16
In reply to Re: How to combat fatigue side effect......, posted by bleauberry on April 12, 2010, at 18:07:56
Thanks for the input- you are definitely right- was harder the first few days so I went back to the stimulant. I am not sure how to do this as I cant afford to get worse for a few weeks or months...but will try to taper the stimulants for a while and add the supplements you mentioned. I have had a FULL workup several times over....and of course the labs all say normal....although I KNOW they are missing something....only thing that shows is low IgG and low IgA levels but no one thinks that is the reason for why I am so fatigued....anyway, I appreciate your input and will discuss with pdoc this week! Thanks again!
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