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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by gardenergirl on August 6, 2010, at 20:40:18
I've had some issues with this year's insurance mandated mail order pharmacy, so I've been up and down with my Cymbalta dosing this year. What I've noticed is that while it does help me with some of the negative thinking and rejection-sensitivity symptoms of my depression, it leaves me emotionally flat. I don't tend to notice this while I'm on it, but when I run out (stupid Medco!), I find myself laughing again. Crying too, but I don't realize that I'm not laughing and not enjoying stuff until I'm off the meds. And if I cry at a stupid, sappy commercial or whatever, it feels right, and I miss that.
So...to get to the point... anyone have any suggestions for antidepressants that don't leave you flat but actually help? I used to do reasonably well on Nardil, but I went off it for some surgery and really appreciated losing all the Nardil weight gain, not to mention not having to think about every single thing I ate, so I don't want to go that route again.
Any suggestions?
Thanks in advance,
gg
Posted by Maxime on August 6, 2010, at 21:18:41
In reply to Cymbalta helps, but I'm so darned flat, posted by gardenergirl on August 6, 2010, at 20:40:18
I used to take Wellbutrin with Cymbalta. I know what you mean about it leaving you feel so flat. I found that the Wellbutrin made it a little better.
Posted by sigismund on August 6, 2010, at 22:11:06
In reply to Cymbalta helps, but I'm so darned flat, posted by gardenergirl on August 6, 2010, at 20:40:18
Well, if you were to lower your dose of Cymbalta would that help with the flatness?
How do you sleep?
What's flatness anyway? Simply not caring? Apathy?
Lower your dose of Cymbalta and add a smidgen of agomelatine at night for some dopaminergic push. That's what I'm wondering about.
Posted by Phillipa on August 6, 2010, at 23:54:45
In reply to Re: Cymbalta helps, but I'm so darned flat » gardenergirl, posted by sigismund on August 6, 2010, at 22:11:06
If you run out of the med don't you go into some withdrawal? Are you saying you feel more without the med? Could it be you need a lower dose or you need no meds anymore. I don't know your diagnosis. Phillipa
Posted by chujoe on August 7, 2010, at 7:09:49
In reply to Cymbalta helps, but I'm so darned flat, posted by gardenergirl on August 6, 2010, at 20:40:18
I've been taking Cymbalta for six months or so. Started at 60 mg, then went to 90, but felt sedated & flat, so went back to 60 mg & that feels much better. You're right, it really cuts down on the negative thinking. I also think the going on & off may potentially cause problems of effectiveness, but that's just a guess.
What dose do you take? Are you taking any supplements with it? I really believe that 2000 to 3000 units of fish oil promotes brain health; also, I have recently begun taking a vitamin B-complex that has 10 mg of B6, which can be stimulating. I think it helps. I'm also investigating tyrosine and DLPA to support dopamine, which is the "emotion neurotransmitter." Speaking only for myself, I'd try supplements before switching from an AD that works.
Posted by gardenergirl on August 7, 2010, at 11:05:09
In reply to Re: Cymbalta helps, but I'm so darned flat » gardenergirl, posted by Maxime on August 6, 2010, at 21:18:41
Hi Maxime, and thanks for your reply. I've taken Wellbutrin in the past. It's been so long, I can't remember how I felt on it. I think that's worth looking at again, at any rate, as I don't remember feeling awful on it.
gg
Posted by gardenergirl on August 7, 2010, at 11:13:38
In reply to Re: Cymbalta helps, but I'm so darned flat » gardenergirl, posted by sigismund on August 6, 2010, at 22:11:06
> Well, if you were to lower your dose of Cymbalta would that help with the flatness?
I don't know that a lower dose helps all that much. It seems that I don't really notice that flatness until it's gone, and that really doesn't happen until I'm off the med.
>
> How do you sleep?I've always had sleep issues, mainly trouble getting to sleep, but also with excessive sleeping when I'm more depressed. I'm on a low dose of trazadone right now to help with that, and it seems to do the trick.
>
> What's flatness anyway? Simply not caring? Apathy?If you think of the "normal" range of emotions as occurring on sort of a wave function, you know, "peaks and valleys" of mood, then a "flat" wave means that highs are not very high and lows are not very low. I don't laugh much at all when I'm flat, and I don't cry at things I'd normally cry at, either. It feels like everything is "meh" or "eh", and that doesn't feel alive enough for me.
>
> Lower your dose of Cymbalta and add a smidgen of agomelatine at night for some dopaminergic push. That's what I'm wondering about.Thanks for the suggestion. I'll think about that.
gg
Posted by gardenergirl on August 7, 2010, at 11:16:54
In reply to Re: Cymbalta helps, but I'm so darned flat, posted by Phillipa on August 6, 2010, at 23:54:45
> If you run out of the med don't you go into some withdrawal? Are you saying you feel more without the med? Could it be you need a lower dose or you need no meds anymore. I don't know your diagnosis. Phillipa
I would be more likely to have some sort of withdrawal effect, but when I start running low, and the insurance company delays or denies another refill for their stupid, bureaucratic reasons, then I taper down. I also taper back up when I finally get my order.
I think that I always felt like I needed a higher dose--started at 30 mg and then gradually increased to 90 mg, because I still always felt a bit apathetic. Though now I'm wondering if that apathy isn't as much feeling emotionally flat, which a higher med increases. Hmmm.
And my diagnosis is atypical depression.
gg
Posted by gardenergirl on August 7, 2010, at 11:27:23
In reply to Re: Cymbalta helps, but I'm so darned flat, posted by chujoe on August 7, 2010, at 7:09:49
> I've been taking Cymbalta for six months or so. Started at 60 mg, then went to 90, but felt sedated & flat, so went back to 60 mg & that feels much better. You're right, it really cuts down on the negative thinking. I also think the going on & off may potentially cause problems of effectiveness, but that's just a guess.
Maybe I should try to hang at 30 mg for awhile and see if that feels better but still helps with the negative thinking. I could also do a better job of managing that with skills and actions instead of just meds, I suppose. Mindfulness and all.
I agree that going on and off isn't a good thing, but it's been my reality for a few months, at least until I realized that the pharmacy was never filling my prescription as ordered. They were giving me fewer due to their own arbitrary limits. I should have caught on to that sooner, but I just never paid enough attention because I never had problems with the previous mail order pharmacy.
>
> What dose do you take? Are you taking any supplements with it? I really believe that 2000 to 3000 units of fish oil promotes brain health; also, I have recently begun taking a vitamin B-complex that has 10 mg of B6, which can be stimulating. I think it helps. I'm also investigating tyrosine and DLPA to support dopamine, which is the "emotion neurotransmitter." Speaking only for myself, I'd try supplements before switching from an AD that works.I was taking 90 mg. Maybe I should hang at 30 mg longer when/if I get my refill again and see if it helps. I've been taking 1000 of fish oil along with a multi vitamin, B comp, calcium, and magnesium. I've backed off the fish oil recently because I seem to bruise way way more easily when I take it, even just when I scratch an itch.
Thanks for the input!
gg
Posted by Maxime on August 7, 2010, at 16:17:20
In reply to Re: Cymbalta helps, but I'm so darned flat » Maxime, posted by gardenergirl on August 7, 2010, at 11:05:09
> Hi Maxime, and thanks for your reply. I've taken Wellbutrin in the past. It's been so long, I can't remember how I felt on it. I think that's worth looking at again, at any rate, as I don't remember feeling awful on it.
>
> ggHi gg, yes the Wellbutrin brought some life into me. I was able to cry, I was able to laugh... it helped. Cymbalta by itself wasn't doing much for me although I did stay on it for over a year which is a long time for me.
Posted by sigismund on August 7, 2010, at 22:09:03
In reply to Re: Cymbalta helps, but I'm so darned flat » sigismund, posted by gardenergirl on August 7, 2010, at 11:13:38
Perhaps a little agomelatine with Cymbalta would be a better version of California Rocket Fuel?
Just the 5HT2C antagonism and some melatonin agonism?
And since your sleep isn't brilliant it might be OK.
There has been some suggestion (I don't know how well founded) that agomelatine plus an SSRi or SNRI would be synergistic. Maybe.
Agomelatine is available in the EU now.
Posted by TriedEveryMedication on August 8, 2010, at 9:27:49
In reply to Re: Cymbalta helps, but I'm so darned flat » sigismund, posted by gardenergirl on August 7, 2010, at 11:13:38
My doc had me on adderall XR + cymbalta for a while.It was an ok combo, at least for me.
Posted by bleauberry on August 9, 2010, at 16:44:54
In reply to Cymbalta helps, but I'm so darned flat, posted by gardenergirl on August 6, 2010, at 20:40:18
Before ditching the whole thing, consider the simple idea that the dose might be too high? If it is causing emotional flatness, it is too high IMO.
Of course, it is a fine line. I mean, you want a little bit of that numbness for the rejection/sensitivity emotional control. But too much numbness renders you useless.
Did you know cymbalta doses can be customized very easy? For example. Let's say you are on 30mg and your want to try 25mg. They don't come in 25mg capsules. Easy. Open a 30mg capsule, carefully remove 10 of the tiny beads inside. Approximately 10 beads is 1mg. Remove 10 beads. Next day remove 20. Next day remove 30. After 5 days you are down to 25mg doses, dropping by 1mg per day for a smooth transition. Stay there for a two weeks to readjust. Then reassess and make your next decision...go down more or go back up.
In addition to lowering the dose, a respectable idea might be to add in a low dose of zyprexa. It stands a good chance of boosting the antidepressant effect and controlling the negative emotions better.
Posted by gardenergirl on August 12, 2010, at 23:10:14
In reply to Re: Cymbalta helps, but I'm so darned flat, posted by bleauberry on August 9, 2010, at 16:44:54
You've given me something to think about and alternatives, and that gives me hope. I appreciate it.
gg
Posted by gardenergirl on August 16, 2010, at 22:03:30
In reply to Thanks everyone!, posted by gardenergirl on August 12, 2010, at 23:10:14
I called my doc to get a scrip for 30 mg. I'm travelling at the moment, and it seems visiting family while unmedicated was not the best decision I've ever made. I feel a bit like the Lloyd Bridges character from "Airplane" who was always saying, "I guess I picked the wrong week to quit drinking/quit smoking/stop sniffing glue" etc.
gg
Posted by Maxime on August 23, 2010, at 18:35:59
In reply to Update, posted by gardenergirl on August 16, 2010, at 22:03:30
*hugs* On the positive side, you are still able to make jokes. I had a little chuckle with your reference to Lloyd Bridges.
Hang in there.
Posted by gardenergirl on August 23, 2010, at 22:00:11
In reply to Re: Update » gardenergirl, posted by Maxime on August 23, 2010, at 18:35:59
Thanks. Glad someone else is old enough to remember that movie. :)
I'm doing better. I think 30 mg Cymbalta is helping, and it's also possible that when I hit Def Con 5, I was PMSing as well. A bit earlier than usual, but whatever. I may see how I do at 30 mg for a couple more weeks, especially once I'm back home in my usual routine, and then evaluate going to 60 mg.
Hope things are improving for you as well.
(((((Maxime)))))
gg
This is the end of the thread.
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