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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 molley55 on February 6, 2011, at 12:10:41
Hi, I am a new poster to this board. I am wondering if anyone has experience with switching from IR Effexor to Cymbalta. I am on Effexor IR 150 mg per day, and have been taking for 2 years. It has never been a great AD for me, (and I have been on most of them) and I previously took Cymbalta which worked well, (although I slept very little). I would like to talk to my doctor about going back to Cymbalta. I cannot do a washout with the Effexor, since I cannot be off work, and I am wondering if we do a cross taper? I have treatment resistant depression. Any suggestions would be appreciated.
Posted by Phillipa on February 6, 2011, at 12:48:40
In reply to Switch from Effexor IR to Cymbalta, posted by molley55 on February 6, 2011, at 12:10:41
Welcome to babble. I have always done cross switches to other ad's. Why did you stop cymbalta? Phillipa
Posted by molley55 on February 6, 2011, at 14:21:51
In reply to Re: Switch from Effexor IR to Cymbalta » molley55, posted by Phillipa on February 6, 2011, at 12:48:40
That is part of the problem I guess..I am still on the Effexor, I just want to go to the Cymbalta, but slowly, while reducing the Effexor. i have read horror stories about withdrawal from Effexor as well as experienced first hand what happens when I am late on dosing.. Is it ok to just taper off one while going onto another since they are sort of in the same class?
Posted by floatingbridge on February 6, 2011, at 19:47:01
In reply to Re: Switch from Effexor IR to Cymbalta, posted by molley55 on February 6, 2011, at 14:21:51
Molley,
I switched like this (from pristiq to cymbalta): one day, starting dose of cymbalta, next day pristiq, next day cymbalta, next day pristiq, then cymbalta onward. Not a hitch. And I too get the effexor/pristiq/cymbalta nightmare.
Personally, I feel I could have just switched, But this made my pdoc feel better :)
However, why back to cymbalta if, from what it sounds like, it wasn't a full ticket?
Good luck!
fb
Posted by molley55 on February 6, 2011, at 20:05:28
In reply to Re: Switch from Effexor IR to Cymbalta » molley55, posted by floatingbridge on February 6, 2011, at 19:47:01
I feel the Effexor has pooped out..and early on I did not really feel like it did the job; but Cymbalta made me a little sped up, but would rather that than this lack of motivation, fatigue and sleeping all the time.
I took Nardil for 8 years and was the only thing that worked really well for me...just haven't gotten back to it due to wash out issues. Only reason went I off Nardil is that a new pdoc felt it was too "old" and decided to take me off of it.. big mistake.
I am also on lamictal, alprazolam
(same small dose for years), a little dexedrine for ADD and augmentation of AD.Thank you so much for input. I just don't want any interactions, although I do know there is no guarantee with these meds. I will run it by pdoc to see if she will be willing to allow me to do this. molley
Posted by bleauberry on February 8, 2011, at 18:31:34
In reply to Switch from Effexor IR to Cymbalta, posted by molley55 on February 6, 2011, at 12:10:41
Yes, you can do a cross taper from one to the other, or just immediately jump to the other. No wash out. It's been a while since I looked at them, but there were a couple studies on pubmed where they did exactly that....switching between those two meds without any interruption. From what I remember, the transitions were relatively smooth.
Posted by molley55 on February 8, 2011, at 22:24:31
In reply to Re: Switch from Effexor IR to Cymbalta, posted by bleauberry on February 8, 2011, at 18:31:34
thank you for the response..I feel a little more confident approaching my doc about the switch. Will keep you all posted about my progress.
Posted by bodhisattva_guy on February 10, 2011, at 1:04:23
In reply to Switch from Effexor IR to Cymbalta, posted by molley55 on February 6, 2011, at 12:10:41
Duloxetine (cymbalta)
http://books.google.com/books?id=Rf8aGXexUKMC&pg=PA79
Duloxetine is an antidepressant that inhibits both serotonin and norepinephrine reuptake. Although similar to venlafaxine(effexor), duloxetines's greater potency at noradrenergic reuptake is thought to contribute to its greater efficacy in pain treatment than venlafaxine. It is approved by the FDA for use in major depression, generalized anxiety disorder, diabetic neuropathic pain, and fibromyalgia. The recommended therapeutic doses range from 40-60 mg daily, but lower doses (20-30 mg daily) should be used for the first week of treatment to avoid adverse effects. Although clinical studies do not support doses higher than 60 mg daily, our experience suggests that higher doses are usually necessary for pain syndromes related to fibromyalgia and other autoimmune diseases. Common adverse effects are nausea, decreased appetite, constipation, headache, dry mouth, insomnia, and somnolence. Men, but not women, treated with duloxetine experience more difficulty achieving orgasm compared to placebo. Increases in both systolic and diastolic blood pressure of approximately 2 mm Hg and an increase in heart rate of 3-4 beats per minute. Some patients experience palpitations but clinically significant changes in electrocardiograms were not different in duloxetine and placebo groups in premarketing studies. The drug is among a class of agents that increase urethral resistance, which may lead to urinary hesitation. Duloxetine has an elimination half-life ranging from 8-17 hours, with hepatic metabolism by P450 isozymes CYPIA2 and CYP2D6. Numerous metabolites are produced, but it is believed that the primary therapeutic effect is from the parent compound.
Venlafaxine's half life is 4-5 hours, but it's metabolite which is just as active has a half-life of 9-15 (11) hours. It is absorbed somewhat slowly, with T[max] of 4-4 hours (it takes that long for body to fully absorb the dose you've taken). It is down-regulated beta-adgrenergic receptors which is associated with more rapid onset of AD effects. It is also considered effective antianxiety agent.Have you considered desvenlafaxine ? Only few differences among these two meds - main one being that 50 mg is good enough for initiation and maintenance. (I suppose it's due to it's much longer half life and t[max]. At lower doses venlafaxine acts on serotonin and higher doses (225 mg and more) causes stronger effect on NE receptors.
It is recommended to switch to longer half-life agent after stopping effexor IR. Similar effect might be achieved by bupropion with 20 h half life after chronic dosing. It is twice as active on NE than DO, and limited or no effects on SE.
Since it is consider to have no effects on SE - you don't have to worry about serotonin syndrome.
But I would be worried about possible psychotic type of effects.
Posted by bodhisattva_guy on February 10, 2011, at 2:09:37
In reply to Re: Switch from Effexor IR to Cymbalta, posted by bodhisattva_guy on February 10, 2011, at 1:04:23
please let me rephrase:
Venlafaxine (Effexor) and Desvenlafaxine (brand name: Pristiq) have are almost the same. Main difference is that 50 mg of Pristiq is good enough for initiation and maintenance. (I suppose it's due to it's much longer half life and t[max]).
Something interesting: at lower doses venlafaxine acts on serotonin and higher doses (225 mg and up) causes stronger effect on NE receptors.
http://en.wikipedia.org/wiki/Desvenlafaxine
Desvenlafaxine is a synthetic form of the isolated major active metabolite of venlafaxine, and is categorized as a serotonin-norepinephrine reuptake inhibitor (SNRI). It works by blocking the transporter "reuptake" proteins for key neurotransmitters affecting mood, thereby leaving more active neurotransmitters in the synapse. The neurotransmitters affected are serotonin (5-hydroxytryptamine) and norepinephrine (noradrenaline). It is approximately 10 times more potent at inhibiting serotonin uptake than norepinephrine uptake. When most normal metabolizers take venlafaxine - 70% of the benefit comes from venlafaxine being metabolized into desvenlafaxine so the effects are very similar.[11] Desvenlafaxine is related to the atypical opioids Tramadol(Ultram) and Tapentadol(Nucynta).
Posted by molley55 on February 10, 2011, at 15:08:31
In reply to Re: Switch from Effexor IR to Cymbalta, posted by bodhisattva_guy on February 10, 2011, at 2:09:37
I am just curious as to why you are concerned about the switchover potentially causing psychotic issues? This would obviously not be good! In the past, the
Cymbalta worked well, but I did have trouble sleeping while on it. The effexor on the other hand has never worked well, causes a great amount of fatigue. I have never done well on SSRI's and am unable to get past the 150 or so mgs of the Effexor due to side effects.Please fill me in on the rationale of your concern, I very much appreciate your input and ideas. Thank you.
Posted by bodhisattva_guy on February 10, 2011, at 21:42:07
In reply to Re: Switch from Effexor IR to Cymbalta, posted by molley55 on February 10, 2011, at 15:08:31
Because, literally, myself, if I were to take bupriopion - I would be concerned about having the effects I had before - feeling as if people were criticisisn and judging me, feeling that everyone was looking at me and silently talking behind my back - basically paranoia. It all depends on dose and individual as well.
Posted by bodhisattva_guy on February 10, 2011, at 22:16:37
In reply to Re: Switch from Effexor IR to Cymbalta, posted by bodhisattva_guy on February 10, 2011, at 21:42:07
I was suffering to Wellspring causing paraniao related issues similar to psychotic side effects.
I tend to use generic names as people from different countries do come here and might be confused if the medication has different brand name. I am making it as www (world wide web friendly as possible. This thread is good example of
Effexor and another medication I brought up - Pristiq. One is called venlafaxine (thing of When and Faxing) and desvenlafaxine \\\ I know they're hard to remember but it helps us all to know generic names.
Posted by bodhisattva_guy on February 10, 2011, at 22:17:30
In reply to Re: Switch from Effexor IR to Cymbalta, posted by bodhisattva_guy on February 10, 2011, at 21:42:07
I was suffering to Wellbutrin causing paranoia related issues similar to psychotic side effects.
I tend to use generic names as people from different countries do come here and might be confused if the medication has different brand name. I am making it as www (world wide web friendly as possible. This thread is good example of
Effexor and another medication I brought up - Pristiq. One is called venlafaxine (thing of When and Faxing) and desvenlafaxine \\\ I know they're hard to remember but it helps us all to know generic names.
Posted by bodhisattva_guy on February 10, 2011, at 22:22:33
In reply to Re: Switch from Effexor IR to Cymbalta, posted by bodhisattva_guy on February 10, 2011, at 21:42:07
Sorry - my spell-checker.. and me feeling sick.
I was referring to Wellbutrin (bupropion) causing paranoia related issues. Those similar to psychotic side effects.
I generic names of meds. People from different countries and might be confused if the medication has different brand name. I am making it as www (world wide web friendly) as possible. This thread is good example of Effexor and another medication I brought up - Pristiq. One is called venlafaxine (thing of When and Faxing) and desvenlafaxine I know they're hard to remember but it helps us all to know generic names.To Dr. Bob - it seem you have a stable server, have you considered upgrading to new forum script - google - open source PHP forum script.
Posted by molley55 on February 11, 2011, at 10:08:17
In reply to Re: Switch from Effexor IR to Cymbalta, posted by bodhisattva_guy on February 10, 2011, at 22:22:33
I will try to remember to use generic names from now on.
Posted by floatingbridge on February 11, 2011, at 12:10:15
In reply to Re: Switch from Effexor IR to Cymbalta, posted by bodhisattva_guy on February 10, 2011, at 22:22:33
Hi bodhisattva_guy,
I hadn't heard of a paranoid reaction to Wellbutrin. Sounds very uncomfortable. I do hope it was the short acting and not the XR version.
Because I'm a poor speller, brand names are easier to remember, so I use them. I
like your idea of supporting this forum as international. It is. Where are you writing from, if you don't mind, just generally? (I understand if you do not wish to disclose your location.) I'm in the States.Kind regards,
fb
Posted by Phillipa on February 11, 2011, at 19:02:50
In reply to Re: Switch from Effexor IR to Cymbalta, posted by bodhisattva_guy on February 10, 2011, at 22:22:33
I feel most posters US, Canada other Countries do know our brand names. When I see a name I don't recognize it's usually a foreign med and I google it. No need to use generic names in my opinion of course. Poor Mollie thought that switching from effexor to cymbalta would cause paranoia and you did say you were from the states in a different thread. Phillipa
This is the end of the thread.
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