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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by kribensis on July 21, 2015, at 18:15:19
I had wanted to try Fetzima and my dr wrote prescription for it but apparently it is not yet available in Canada (according to pharmacist).
My choices are effexor or cymbalta. I did well for a few years on effexor until I needed to go up to higher and higher doses and then it pooped out. That was 5 years or so ago.
My questions are:
-which one is the most likely to be effective at a lower dosage (have anxiety about taking high amounts of any med)
-which one is less likely to cause weight gain (last time effexor was weight neutral for me)Thanks in advance.
Posted by rjlockhart37 on July 21, 2015, at 19:50:58
In reply to Effexor or Cymbalta, posted by kribensis on July 21, 2015, at 18:15:19
i never took Effexor, but i knew people who i randomly bumbed into talking about meds, effexor is kinda like a stimulant, not like wellburin, but it's more.....activating......i've taken cybalta and it mainly just improves mood, not so much as a waker upper .... like wellbutrin and effexor.....
i would try cymbalta, it has less side effects and treats pain, and more variety of things......
effexor was a huge blockbuster for a while, lots of doctors prescibred it, then after that cymbalta.....
give it a try it is a good mood med
Posted by SLS on July 21, 2015, at 21:56:36
In reply to Effexor or Cymbalta, posted by kribensis on July 21, 2015, at 18:15:19
> I had wanted to try Fetzima and my dr wrote prescription for it but apparently it is not yet available in Canada (according to pharmacist).
>
> My choices are effexor or cymbalta. I did well for a few years on effexor until I needed to go up to higher and higher doses and then it pooped out. That was 5 years or so ago.
>
>
> My questions are:
> -which one is the most likely to be effective at a lower dosage (have anxiety about taking high amounts of any med)
> -which one is less likely to cause weight gain (last time effexor was weight neutral for me)
>
> Thanks in advance.
How high did you go with Effexor?Do you experience any unexplained aches and pains?
Is Pristiq (desvenlafaxine) available? It is an active metabolite of Effexor and is effective at a much reduced dosage. You may respond wonderfully at 100 mg/day.
Cymbalta is a good drug, too. I don't yet know how one can predict which drug will work best for any one person. I have taken both Pristiq and Cymbalta. Neither worked well for me, unfortunately. Either drug would be a reasonable choice. If one doesn't work, you can always try the other one. I lean towards Pristiq. However, if you have aches and pains, you might want to try Cymbalta first.
Sorry to make your decision harder.
- Scott
Posted by kribensis on July 21, 2015, at 22:12:34
In reply to Re: Effexor or Cymbalta » kribensis, posted by SLS on July 21, 2015, at 21:56:36
Thanks, both of you, for your responses.
I do have some aches and pains but it is mainly the depression that I am concerned about and I think that I would do better with something that is more simulating.
I did take pristiq for a while and it was just 'okay'. I have digestive issues (do okay because I am really, really careful with my diet) but anything like breaking down a hard tablet like pristiq just isn't great. I found that I would have a lot of ups and downs and zaps even when still taking it which I attributed to the pristiq sometimes getting into my system and sometimes not.
I would actually rather take something that is NOT a XR even if that means I have to take smaller amounts more often during the day but most meds now seem to be XR.
At least with the effexor, I can open the capsules and even though the beads are XR I think my gut has an easier time with them.
At one time, I think I went up to 300 on effexor. As I said, worked really well till it pooped out.
I seriously hate this. I am having a melt down today- I try and keep myself together and I do everything that a person *should* do to help themselves, exercise, eat well, get to bed early, meditate, etc. and I STILL have this issue. And the only time in my life I have felt basically "normal" was those few years on effexor. It just feels like such a struggle and now I have anxiety about meds being hard on the liver or heart, etc. It just sucks that it has to be this hard. Because I have done everything that I can think of to help myself, I know this must be a physical brain type issue (runs in my family) but it totally sucks and I'm down and feeling sorry for myself. Even if I do find a med that helps, I am really only guaranteed to feel okay for a period of time, then have to go through the hassle of weaning off and dealing with discontinuation symptoms. This just isn't fair. I feel like I'm in slow motion when I'm like this, my brain doesn't work, I can't speak clearly, I feel like I can't focus properly and everything just is slow, slow slow...
Posted by SLS on July 22, 2015, at 7:32:34
In reply to Re: Effexor or Cymbalta, posted by kribensis on July 21, 2015, at 22:12:34
> I seriously hate this. I am having a melt down today- I try and keep myself together and I do everything that a person *should* do to help themselves, exercise, eat well, get to bed early, meditate, etc. and I STILL have this issue. And the only time in my life I have felt basically "normal" was those few years on effexor. It just feels like such a struggle and now I have anxiety about meds being hard on the liver or heart, etc. It just sucks that it has to be this hard. Because I have done everything that I can think of to help myself, I know this must be a physical brain type issue (runs in my family) but it totally sucks and I'm down and feeling sorry for myself. Even if I do find a med that helps, I am really only guaranteed to feel okay for a period of time, then have to go through the hassle of weaning off and dealing with discontinuation symptoms. This just isn't fair. I feel like I'm in slow motion when I'm like this, my brain doesn't work, I can't speak clearly, I feel like I can't focus properly and everything just is slow, slow slow...
You describe severe depression very well. Some of the following suggestions will not be palatable, but I think you should at least be aware of them.
1. Aches and pains are sometimes symptoms of the depressive disorder itself. Cymbalta is known to help with these. I don't know if the presence of pain is an indicator of responsivity to Cymbalta, but the drug is still an effective drug, and a reasonable choice.
2. As per your description, you might have psychomotor retardation as a prominent feature of your illness. This presentation is often responsive to tricyclics (TCA). I am having some luck with nortriptyline in combination with other drugs. Desipramine is a stronger noradrenergic drug, and can be helpful. It usually does not produce weight-gain as nortriptyline sometimes can. I actually did relatively well with Effexor after it was augmented with nortriptyline.
3. At 300 mg/day, your dosage of Effexor was still below the maximum recommended by the drug manufacturer (375 mg/day). Some people don't do well until the dosage is brought up to 600 mg/day. If you do go back to Effexor, you might consider going higher than 300 mg/day.
http://www.rxlist.com/effexor-drug/indications-dosage.htm
4. If you are partially responsive to either Effexor or Cymbalta, you might consider continuing the drug and building a regime around it. You can add:
- Wellbutrin
- Remeron
- Low-dose lithium (300 - 600 mg/day)
- Abilify
- Lamictal
- TCA5. Paxil is often overlooked. It is very effective, and can produce a response when no other SSRI can. However, it is likely to produce weight-gain.
6. At some point, you might need to consider MAOIs. Not all doctors are comfortable using them for lack of experience and their reliance upon the patient to be vigilant in following food and medication restrictions.
- Nardil is great when comorbid anxiety disorders are present, but weight-gain is to be expected. I have more trouble with hypotension with Nardil.
- Parnate is usually chosen for a case like yours where anergia or psychomotor retardation are present.
- Marplan is not usually chosen first, but I found it to be a clean and gentler drug that did not produce weight-gain.I will be interested to know what you decide. I hope you hit the bullseye with just one drug.
- Scott
Posted by kribensis on July 22, 2015, at 10:24:28
In reply to Re: Effexor or Cymbalta » kribensis, posted by SLS on July 22, 2015, at 7:32:34
Thanks Scott.
I feel so overwhelmed and even more anxious and depressed with all of this.
I had not looked into desipramine before and have been reading about it since reading your post.
Any other comments about that one (desipramine?). I am thinking about trying that one first instead of effexor. (I did try adding wellbutrin when effexor pooped out, didn't work made me worse which was the same when I tried it as a stand alone last year).
Posted by Christ_empowered on July 22, 2015, at 12:17:04
In reply to Re: Effexor or Cymbalta, posted by kribensis on July 22, 2015, at 10:24:28
Maybe you could start high on the cymbalta, w/ a sedative or low dose neuroleptic as needed? I was started on 90mgs/day, and it was helpful for a while. Some people go up to 120.
Posted by SLS on July 22, 2015, at 14:02:39
In reply to Re: Effexor or Cymbalta, posted by kribensis on July 22, 2015, at 10:24:28
> Thanks Scott.
>
> I feel so overwhelmed and even more anxious and depressed with all of this.
>
> I had not looked into desipramine before and have been reading about it since reading your post.1. Desipramine will cause your heart rate to increase. Too many people quit desipramine because their resting HR goes up to 100 beats per minute. This is usually not dangerous, but it is sometimes a good idea to get a ECG (EKG) before starting the drug and then at some point afterwards. You might "feel" your accelerated HR and experience palpitations. I found that these disappear after awhile. Be sure to tell your doctor of any cardiac conditions you may have. A resting HR of over 120 should be of concern as being tachycardia.
2. Other side effects of desipramine may include dry mouth, constipation, blurred vision, drowsiness, dizziness, tremulousness, difficulty urinating, insomnia, and sweating. Many of these things appear early in treatment and become milder over time. It is unlikely that you will get all of the side effects listed. I prefer these side effects to the apathy, amotivation, and sexual side effects that SSRIs can produce.
3. I would start desipramine at 25 mg/day and raise the dosage gradually (perhaps by 50 mg every 5 - 7 days). 150 - 200 mg/day is usually sufficient. However, 300 mg/day is often needed for more severe cases. A minority of people metabolize TCAs very slowly, for which the dosage of desipramine should be cut in half. You might want to use blood tests to help determine drug levels.
- Scott
Posted by phidippus on August 5, 2015, at 10:47:19
In reply to Effexor or Cymbalta, posted by kribensis on July 21, 2015, at 18:15:19
Cymbalta has greater ki for norepenephrine than effexor hence its utility in pain management.
Cymbalta can be effective at lower doses and has little propensity for causing weight gain.
Eric
Posted by kribensis on August 5, 2015, at 10:56:47
In reply to Re: Effexor or Cymbalta » kribensis, posted by phidippus on August 5, 2015, at 10:47:19
Thanks Eric (and everyone else who replied to this thread). I ended up getting a prescription for Effexor but haven't taken it yet. I think Cymbalta may be a better choice but the concerns about liver issues while on it really freaks me out.
I hate feeling anxious about taking meds. UGH. It sucks and I'm here miserable feeling afraid to take anything.
Posted by phidippus on August 5, 2015, at 11:52:35
In reply to Re: Effexor or Cymbalta » phidippus, posted by kribensis on August 5, 2015, at 10:56:47
Are you afraid when you take an ibuprofen? A vitamin supplement? If not, why do you think that is?
Eric
Posted by kribensis on August 5, 2015, at 14:41:38
In reply to Re: Effexor or Cymbalta » kribensis, posted by phidippus on August 5, 2015, at 11:52:35
Eric:
Ibuprofen- yes, do not take it or at least haven't for the past 5 years. Vitamin supplements not quite as much but am still cautious and take only conservative dosages of those and not regularly.
**I was not always like this. 5 years ago had a severe reaction to a botox injection that I received for a muscle spasm. Basically had full on botulism, was hospitalized and it took me 4 years to recover (still have flares of symptoms). I felt like a an idiot that I did not look into possible side effects before that injection as it changed the course of my life. Since then I read all possible side effects for meds which keeps me paralyzed in getting started on anything because I am so afraid of a serious reaction.
Posted by phidippus on August 5, 2015, at 15:42:09
In reply to Re: Effexor or Cymbalta » phidippus, posted by kribensis on August 5, 2015, at 14:41:38
But that's Botox, made from botulism. I think the chances of getting a serious reaction from Botox is well above norm. Whereas the chances of having a serious reaction from a psych med is far less.
Eric
This is the end of the thread.
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