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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by SLS on April 19, 2010, at 9:19:10
I have been taking Savella (milnacipran) for 5 weeks. I have been at 200mg for one week. I experienced a transient 3-day antidepressant response at the 2-week mark using a dosage of 100mg. This is a consistent pattern for me. Usually, I do not benefit further from a drug once that brief response ceases. Up until now, the only side effects that I have experienced are some dry mouth and amotivation. The amotivation has been troublesome as I am not getting anything done. It affects me enough to want to discontinue the drug. However, I will take it for one more week. If there is no improvement, I will probably begin tapering.
Strangely, I am feeling a bit brighter today.
- Scott
Posted by Phillipa on April 19, 2010, at 11:09:17
In reply to Savella at 200mg., posted by SLS on April 19, 2010, at 9:19:10
The three day positive blip? I seem to get the same thing? This time I hope it works and continues for you. Love Phillipa
Posted by ed_uk2010 on April 19, 2010, at 13:55:29
In reply to Savella at 200mg., posted by SLS on April 19, 2010, at 9:19:10
> I have been taking Savella (milnacipran) for 5 weeks. I have been at 200mg for one week. I experienced a transient 3-day antidepressant response at the 2-week mark using a dosage of 100mg. This is a consistent pattern for me. Usually, I do not benefit further from a drug once that brief response ceases. Up until now, the only side effects that I have experienced are some dry mouth and amotivation. The amotivation has been troublesome as I am not getting anything done. It affects me enough to want to discontinue the drug. However, I will take it for one more week. If there is no improvement, I will probably begin tapering.
>
> Strangely, I am feeling a bit brighter today.
>
>
> - ScottI'm sorry that it's not helped, Scott. It does sound like you've given it a decent trial, which is very important as you well know.
Posted by bleauberry on April 19, 2010, at 17:28:26
In reply to Savella at 200mg., posted by SLS on April 19, 2010, at 9:19:10
Well, I guess you probably won't want either of these ideas, but worth mentioning I guess. In small case studies, Risperdal was like magic mixed with Savella particularly in treatment resistant patients. The lowest dose of .5mg was all that was needed, response time was within 4 days. Not sure how that would mix with abilify.
If one of the TCAs helped you, it might be worthwhile to ramp up on it again combined with savella before completely dumping everything.
You have on many occassions comforted others through their torturous waiting in order to give the brain the time it needs to adapt. Usually in the 6 to 12 week range realistically. With savella, the best results seem to show up in the 8 to 12 week range.
I guess what I am saying is, consider adding something else to it before dumping it, and consider giving it more time. I know, believe me I know, when things feel like mush it's hard to keep going.
From a completely different angle, it could be the dose is just too high. Maybe a lesser dose for longer time?
Just some thoughts to ponder. Feeling pretty lousy myself the last few weeks. The whole game is a tough one, probably the toughest thing we'll ever experience in our lifetimes.
> I have been taking Savella (milnacipran) for 5 weeks. I have been at 200mg for one week. I experienced a transient 3-day antidepressant response at the 2-week mark using a dosage of 100mg. This is a consistent pattern for me. Usually, I do not benefit further from a drug once that brief response ceases. Up until now, the only side effects that I have experienced are some dry mouth and amotivation. The amotivation has been troublesome as I am not getting anything done. It affects me enough to want to discontinue the drug. However, I will take it for one more week. If there is no improvement, I will probably begin tapering.
>
> Strangely, I am feeling a bit brighter today.
>
>
> - Scott
Posted by SLS on April 19, 2010, at 17:44:19
In reply to Re: Savella at 200mg. » SLS, posted by bleauberry on April 19, 2010, at 17:28:26
Hi BB.
Yes, it is difficult to know what to do. I am leaning against the idea that there is a narrow therapeutic window for Savella that occurs at very low dosages. It just doesn't seem like the right thing to gamble on and commit 12 weeks to. I remain open-minded, though. I am still taking nortriptyline at a dosage of 150mg.
There is an interesting article on Medscape comparing milnacipran at dosages of 100mg and 150mg.
- Scott
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http://www.medscape.com/viewarticle/528303
Remission Rates With Milnacipran 100 mg/day and 150 mg/day in the Long-Term Treatment of Major DepressionKazuo Okumura; Toshiaki A. Furukawa
Background:
The aim of this study was to determine remission rates during treatment with two different dosages of milnacipran, and the effect of milnacipran therapy for at least 1 year on the maintenance of remission and tolerability, in outpatients with major depression.Methods:
The study included 41 outpatients with major depression who initially received milnacipran 50 mg/day for 12 weeks, followed by a dosage increase to 100 mg/day for 12 weeks. Patients who achieved remission (17-item Hamilton Depression Rating Scale [HDRS] scores =7) after 12 weeks of milnacipran 100 mg/day treatment continued at the same dosage and were followed for at least 1 year. For patients who had decreased HDRS scores, but failed to attain remission, the dosage of milnacipran was increased to 150 mg/day, and those who achieved remission were then followed for at least 1 year.Results:
Eight out of 41 patients were withdrawn from the study prematurely because of adverse events (eight events in six patients: nausea, thirst, urinary discomfort, rapid pulse, palpitations, staggering sensation or sweating) or as a result of the patient's decision (two patients). Thirteen (31.7%) of 41 patients achieved remission during treatment with milnacipran 100 mg/day. Of the remaining 20 patients, 17 underwent a dosage increase to 150 mg/day, and 13 achieved remission at a second assessment (cumulative remission rate: 63.4%). No adverse events or recurrence of symptoms were found in any of the patients who achieved remission during the subsequent follow-up period of a minimum of 1 year.Conclusions:
The results of this study showed milnacipran 150 mg/day and 100 mg/day to be effective and well tolerated in the long-term treatment of outpatients with major depression, and indicated that a dosage of 150 mg/day is an effective therapeutic option for depression when a dosage of 100 mg/day does not provide a satisfactory response.
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Posted by SLS on April 24, 2010, at 15:59:38
In reply to Re: Savella at 200mg. » bleauberry, posted by SLS on April 19, 2010, at 17:44:19
I have decided to discontinue Savella. I have been tapering it over the last few days and should be done with it today. I have experienced anxiety and sleep disturbance as withdrawal effects.
I have not seen a hint of improvement since the brief response I experienced in week 3. I am unwilling to give it any more time. I have seen this happen too many times in the past. At 200mg, I am very much affected cognitively. I have been dumber than dirt and unable to remember my own name. Since reaching 100mg, amotivation has prevented me from getting anything done, and my lack of interest has worsened. I would not say I was apathetic, though. Effexor 300mg did not affect me in these ways. Neither did Cymbalta.
The only conclusion I can come to is that Savella is not the right drug for me. I would not extrapolate my experience to others.
- Scott
Posted by ed_uk2010 on April 24, 2010, at 16:13:02
In reply to Re: Savella at 200mg., posted by SLS on April 24, 2010, at 15:59:38
Hi Scott,
Sorry to hear that it's been a bad experience for you. Do you have any plans of what to try next? Perhaps agomelatine, unless you have already tried it.
Posted by SLS on April 24, 2010, at 17:05:10
In reply to Re: Savella at 200mg. » SLS, posted by ed_uk2010 on April 24, 2010, at 16:13:02
> Sorry to hear that it's been a bad experience for you. Do you have any plans of what to try next? Perhaps agomelatine, unless you have already tried it.
I would probably try agomelatine if it were readily available and affordable.
I'm not sure what to do next. My doctor mentioned Marplan, which surprised me. I didn't think he had the guts to go with another MAOI. It renews my faith in him. I guess it makes sense. I never gave it a fair trial.
How have you been faring these days?
- Scott
Posted by ed_uk2010 on April 24, 2010, at 19:30:23
In reply to Re: Savella at 200mg. » ed_uk2010, posted by SLS on April 24, 2010, at 17:05:10
I'm quite well, thanks. I could be better but I think my circumstances need to change for that to happen.
I think Marplan sounds like a good idea. It might help and you have nothing to lose by giving it a proper trial.
I'm not convinced that agomelatine is a robust antidepressant but I thought I'd mention it because I was fairly sure that you hadn't tried it. I believe it is not marketed in the US, which is a shame. It good to have plenty of options.
This is the end of the thread.
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