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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by floatingbridge on October 24, 2010, at 17:22:58
I should be able to sideways transition to cymbalta from pristiq, correct?
(Someone mentioned a pristiq washout for cymbalta. That can't be true...I'm hoping.)
Anything realistically to be gained, mood and painwise, both of which have increased lately?
In the event of washing out to a maoi, are both equally difficult?
In an easy world, I could move laterally to cymbalta, which if it was ineffective, would have any easier washout than effexor.
I gotta hope....
Posted by maxime on October 24, 2010, at 19:38:49
In reply to pristiq to cymbalta?, posted by floatingbridge on October 24, 2010, at 17:22:58
Hi FB
I wouldn't call it a washout per se, but you should slowly reduce the Pristiq before starting the Cymbalta. First, it's never good to stop a medication abruptly. Secondly, if you have a reaction when you start Cymbalta you have no way of knowing whether or not the Cymbalta is causing it or if the combination of the two meds is causing the reaction. I don't think you have to go without taking either (ie. a true washout like when you start an MAOI). Just reduce the Pristiq before starting the Cymbalta.
I hope Cymbalta helps you. Since you are taking it for pain and depression you should be aiming for 120 mg. The normal dosage of Cymbalta is 60 mg, but studies indicated that for pain, you need to go up to 120 mg. Has your doctor talked to you about this yet?
As usual ... keep us posted! :)
Posted by floatingbridge on October 24, 2010, at 21:20:30
In reply to Re: pristiq to cymbalta? » floatingbridge, posted by maxime on October 24, 2010, at 19:38:49
Hi Maxime, thanks for writing :)
Have you taken cymbalta yourself? If so, what was it like--though your reactions can vary from mine.
120 for pain? Jeez, I've never done well to date on high doses of ADs. Hey, it could work, I'm just saying yikes.
Well my pain med physiatrist brings it up, the rheumy brought it up. My pdoc didn't jump on it. He's away for a few more weeks.
I want to try what I can before considering an maoi.
Thanks for explaining the washout. I've done that cross taper before. Pretty painless.
Cymbalta is known for it's difficult discontinuance, isn't it?
You sound a little brighter. Yes :) ?
Oh, I found a mbct group to join. Once a week indefinitely. When I practiced in a group before, the benefits were pretty palpable. It's indicated for depression, ptsd, and chronic pain.
Thanks Maxime.
Posted by maxime on October 24, 2010, at 23:31:43
In reply to Re: pristiq to cymbalta? » maxime, posted by floatingbridge on October 24, 2010, at 21:20:30
Hi again!
Yes, I was on Cymbalta for over a year. At the time, it did help my depression a lot. I only went up to 60 mg because at that time I didn't have pain in my body the way I do now. I had no side effects from it from what I can remember. It helped my anxiety as well as my depression. But then, like most ADs, it stopped working for me. That is when we decided that I would go back on Parnate.
When I was doing the washout I didn't suffer physically (no brain zaps etc), but my depression did worsen. Instead of a two week wash out it was 4 weeks because I was away on holiday. My depression got so bad that my friend tells me now that she almost took me to the hospital. I was crying all the time, I was anxious ... I was a MESS.
I really liked Cymbalta. I liked it more than Effexor because it didn't make me hypomanic the way Effexor did. I really wish it hadn't stopped working for me. :(
Maybe you won't need to go up to 120 mg to help with pain. Maybe 60 mg will be sufficient. You never know.
I think Phillipa used it for pain. I don't know how high she went with the dosage.
If Cymbalta doesn't work, which MAOI were you thinking of trying? Did your pdoc mention MAOIs or are going have to win him over?
FB, I truly hope that this will be the med for you. That it will help the pain and the depression. I will keep you in my prayers.
Maxime
Posted by maxime on October 24, 2010, at 23:38:36
In reply to pristiq to cymbalta?, posted by floatingbridge on October 24, 2010, at 17:22:58
I found this post on a discussion board for you. I wanted to give you some hope.
------------------------------------I have pain in my arm due to severe nerve damage from 23 yrs ago. The frequency and intensity had progressed so much that I sought medical help 6 yrs ago and began taking vicodin which progressed to percocet, oxycodone, oxycontin, morphine sulphate, and on a few trips to the ER, large amounts of morphine & delodid.
The amounts of these narcotics necessary to successfully relieve me from the worst episodes of pain had become truly staggering!
Meanwhile, we tried such treatments as neurontin, carbamazapine, amatriptaline, and a couple others I cant think of right now. No relief or change of any kind resulted from any of them other than bothersome side-affects.
Several months ago I began taking 30mg of cymbalta daily. I have been absent of any significant episodes ever since! Cymbalta has changed my life! Unfortunately there are side-affectsI struggle to wake up fully in the morning, and occasionally, even frequently I experience light-headedness. When you weigh these side-affects against frequent, debilitating pain, there is no question about it. Im delighted to make the trade!
I can truly understand & sympathize with those searching for relief of debilitating pain. Especially when your doctors, who never had to deal with the experience of pain so intense that it makes you question the value of continuing to live, stops listening to you. But you really have no choice. Seek out alternatives to narcotic pain meds. Their effectiveness decreases as your body builds tolerance. Then youre left with two problems: pain, and physical dependence on meds that used to work but just dont have the same positive effect they used to have. Theres nothing like the experience of withdrawal from opioids on top of chronic, mind-numbing pain. Youll lose your sanity! However, they can buy you enough time to find a successful treatment that won't create the additional problem. There is a treatment out there that will work for you. Mine was cymbalta.
Posted by floatingbridge on October 25, 2010, at 1:31:18
In reply to Re: pristiq to cymbalta?, posted by maxime on October 24, 2010, at 23:38:36
Maxine, thanks so much for all the great information and support (hug).
I do agree with the anonymous author you quote that I sense from my brief experience the potentially fleeting effectiveness of opoid/opiate pain killers--for me, that is, strictly speaking. My body started to just suck them up. Building tolerance as quickly as I do is
frightful because, I mean, pain is terrible, horrible and if opiates don't cut it.... My mind can go some scary places.And now with dexedrine, well, it's different. More simply doesn't work. Period. If 60 a day doesn't cut it, and over this past summer through now it
doesn't--I can really panic. When intense fatigue isn't curbed by amphetamines, what do I do?Interesting that the dexedrine still provides mental clarity (relatively
speaking). I just can't stay out of bed or avoid lying down.About Maoi's...I don't know. I don't really want to go there. For a while I thought emsam could be the ticket. Parnate next because of it's energizing affect. One Stanford doc said I'd be a good candidate for those two or rTMS. My own pdoc wasn't sure, so I balked.
I'm setting up a second consultation with the other Stanford doc in the dept. Now that pain is an issue, ptsd triggers more apparent, and I'm more fully accepting the chronic status of this illness, I have the same questions, more questions, I really need info about how to stay alive and live a decent life.
I'm looking at other add-ons like mindfulness practice, adequate exercise (I have PT for chronic fatigue next week), diet (almost one week w/o wheat for arthritis).
Oh boy.
Thanks Maxime. I really appreciated that boost your posts provided.
(((Hugs)))
Posted by Phillipa on October 25, 2010, at 10:38:20
In reply to Re: pristiq to cymbalta? » maxime, posted by floatingbridge on October 25, 2010, at 1:31:18
FB we haven't talked at all. But the cymbalta was given to me by a pdoc when it was new he had a supply from the drug companies only pdoc in that area and he gave me the meds each week to take home. Original thought was the typical you're depressed you have anxiety. I took up to 60mg for three months noticed nothing and then found babble and saw it didn't work for a certain poster and figured this new med was another bust so stopped it first to 30mg for a week no problem with that the a week going off the last 30mg. Think that is when I went back on the luvox. But what I noticed after going off the cymbalta was that I had back pain. So I guess it covered it. I was lifting weights in the gym at the time. About a year later found out about the osteoporosis and osteoarthritis. So I guess it masked it for lack of better words. Pretty sure I know the poster who stopped the pain meds for cymbalta. Today that poster is getting nerve blocks for a bum shoulder injury. I don't think on any meds at all? Sounds like things arent that good. Does your profile condition status need to be changed or is it correct that MDD is controlled? I would think you could just switch from pristiq to cymbalta? But we are all different. I had always wanted to try ENSAM also but pdoc said would be too stimulating for me. Love Phillipa
Posted by floatingbridge on October 25, 2010, at 13:38:57
In reply to Re: pristiq to cymbalta? » floatingbridge, posted by Phillipa on October 25, 2010, at 10:38:20
Hi Phillipa,
I can't figure out how to change my signature! Silly, huh? Guess it does need to be ammemded.
Thanks for your experience. So cymbalta is actually an AD you can tolerate. Does luvox do a better job with anxiety for you?
I guess I'd be willing to try it. I loathe loathe loathe and dread med changes. But, yea, not doing so well. Thanks Phillipa for being here. Hugs.
Posted by Phillipa on October 25, 2010, at 21:18:53
In reply to Re: pristiq to cymbalta? » Phillipa, posted by floatingbridge on October 25, 2010, at 13:38:57
FB actually none help with anxiety. Was on pretty high dose benzos when on cymbalta. Luvox was the only med I ever took ad wise that had no side effect. Never could feel a thing and kept waiting. At one time was on 250mg of luvox and ativan and felt great. Rest is long story as to why it was taken from me literally. Best for an e-mail Phillipa
Posted by PartlyCloudy on October 27, 2010, at 21:19:34
In reply to pristiq to cymbalta?, posted by floatingbridge on October 24, 2010, at 17:22:58
Hello FB
I'm switching back to Cymbalta from Pristiq partially for the pain relief qualities it gave me, as well as the AD properties.
My pdoc has had me follow a taper and wash-out period from the Pristiq (gahhh) and I go back on the Cymbalta at an initial dosage of 30mg tomorrow. My pdoc is very cautious with my treatment as I've had poor responses, poop-outs and recurring PTSD triggers that my antidepressants struggle to keep on top of. My back pain is psychosomatic; such a quaint, old fashioned term. All I know is that structurally, there is nothing wrong with my back AND I suffer severe chronic pain with spasms that are set off when I experience emotional trauma and re-trauma.
I've been seeing my pdoc for over 4 years now and trust him and his directions. Although I don't claim to understand the reasoning behind the medication taper and wash-out between stopping the Pristiq and re-starting the Cymbalta, I am not one to question my pdoc's experience and instructions.
I look forward to my relief as the last couple of weeks have been uncomfortable (zapping brain now), teary, and my emotions have been rather explosive. I feel badly for my spouse :-(
take care
PartlyCloudy
Posted by floatingbridge on October 28, 2010, at 11:04:44
In reply to Re: pristiq to cymbalta? » floatingbridge, posted by PartlyCloudy on October 27, 2010, at 21:19:34
Hi Partly Cloudy,
Today you begin cymbalta? I hope you feel some immediate relief. Were you tapering down without anything? If I understand correctly, whew, that would be tough. My doc is cautious, too, which ultimately I like. Curbs my impulsiveness--and he's worked pretty hard on getting and keeping me stable.
I do have lower back damage. Most docs say it should not cause the pain it does. My physiatrist (that is spine doctor) thinks my pain is justified physically and knows it's also tied to my emotions.
I find massage helps in a cumulative way and as maintenance. There is something called myofascial pain syndrome? Have you heard of it? Trigger points that cause referred pain often emotionally activated.
I had two good days in a row with very little pain. Yesterday, while contemplating a larger family issue with
in-laws, I went from annoyed to confused to sad. Bingo. As I recall, my feet and legs began to ache and nag, and then I thought oh, shoot, darn, it's coming on. Then I remembered
something I learned about myself in dbt. I'm 'allergic' to sadness :( Oh well.When I mentioned to my spine doctor how instantaneously this all was happening, he said, good, now you can
change it. :/Thanks so much for writing. However you (and your spouse) made it through this--kudos! Your posts have been very helpful to my decision making process. I'll let you know what changes I make. I see my pdoc in a week.
What therapeutic dose are you aiming towards?
Best to you, and be well,
fb
Posted by PartlyCloudy on October 28, 2010, at 13:58:32
In reply to Re: pristiq to cymbalta? » PartlyCloudy, posted by floatingbridge on October 28, 2010, at 11:04:44
We are aiming for a pretty low therapeutic dose - 60mg of Cymbalta. I'm already on Seroquel at night for sleep (blissfully) and it helps, so I'm told, for depression; but the taper and wash out from Pristiq was characterized primarily by tears and overwhelming feelings of sadness. I've also been on a daily total dosage of 1.5mg of Xanax for years now to help manage my anxiety.
My back pain has been responding well to acupuncture treatment and some chiropractic therapy from the same practioner. I wish that massage was an option for me, but even the lightest of tissue touch leaves me quivering in pain for days afterwards - I believe it's one of the traumatic triggers that my back responds to :-( My favorite place to be when I'm in the worst pain is soaking in my (obscenely large and deep) bathtub, with hands full of Epsom salts, essential oils and softly lit candles around the tub to soothe my mind as my body is cradled in the tepid water.
The irony of it all is that my PTSD that brought on this latest necessity to adjust my medications was triggered in a large part by my starting the process of applying for disability. If I didn't feel so very awful I might be able to dig up some gallows laughter. As it is I found a resource to help with the enormous red tape involved.
I will admit to my pdoc recommending another medication to help with the transition of the taper that I just didn't handle well, and that was the addition of Remeron (Mirtazapine). It made me into a slumbering, lumbering zombie that was only able to eat, eat, and eat, and that created its own anxiety. I'm actually on vacation (!) and did not want to spend it sleeping and gorging myself without any kind of pleasure. I do not doubt that the Remeron would have abated my discomfort during the transition, but I wasn't prepared for its own set of side effects and problems.
Already, I am feeling no brain zaps today (yet?). Still pretty emotional and weepy but hanging in there.
How are you doing?
pc
Posted by floatingbridge on October 28, 2010, at 22:07:53
In reply to Re: pristiq to cymbalta? » floatingbridge, posted by PartlyCloudy on October 28, 2010, at 13:58:32
No brain zaps? That sounds very good. I hope the weepiness ends very soon. Could be starting tomorrow?
I like accupuncture, too, for general maintenance, but doesn't seem to help the pain-- :( Wish it did. I certainly gave it a good go. Hmmm. I could try it again in conjunction with whatever lies ahead.
I'm on xanax CR maintenance. Has some muscle relaxant effect. When my back is very tight, (like tonight) I take 2-4 mg of zanzflex, a muscle relaxant that seems pretty transparent, unlike flexeril.
I have never tried remeron; it was part of a friend's ticket to remission. She gained some weight, but felt good again, and I personally thought she looked just lovely,
and seeing her smile and laugh was great. I was given trazedone (sp?) once,
and that felt like being bludgeoned to sleep.Life is deeply ironic--there is no need to embroider, is there? Godspeed on your disability case. I suspect my ptsd is, in part, 'quickening' in reaction to my son's
growth. He's reaching an age which was the beginning of troubled times for myself.I'm trying to thinking of some other safe
therapy. Ahh. Cranial Sacral therapy,
though there is a still hand underneath
the sacral area. Maybe your chiropractic does this. I find it very effective. Also
another 'energy' technique called 'zero-balancing'. I've never had it done. I found a massage therapist I feel comfortable with. It was very brave of me to 'shop' for one, let alone have a massage. I did not want to be touched. Now, I still feel resistance to going which dissipates after arrival.The past few days have been tough--and today was a whopper. Uncontrollable
weeping. I didn't feel the edge till I fell. Luckily I was home alone. Frankly, I feel unable to have much say in how I'll feel on a day to day basis. Yes, it's real, isn't
it? In that I'm not faking? But I feel out of control, not of my actions, but of my capabilities. Argh. I want my pdoc! (He's been away for 3 weeks.) Oh well.You're on vacation...at home?
Hope that cymbalta kicks in fast!
Posted by PartlyCloudy on October 29, 2010, at 18:30:07
In reply to Re: pristiq to cymbalta? » PartlyCloudy, posted by floatingbridge on October 28, 2010, at 22:07:53
I'm on vacation out of town, but with my laptop (more for my husband than for me, though I did update my blog). It's a blessing how quickly the Cymbalta seems to be taking effect. My back has been fairly quiet this week and if anything, feeling better as the anxieties of the past several weeks and months have been helped by this short time away.
I have always responded very positively, almost euphorically, to acupuncture. Even as a teenager I sought relief from my migraine headaches and in the big city's Chinatown I found an alternative to the heavy duty pain relievers that my family doctor had resorted to prescribing for me.
Accepting that life will always have these ebbs and flows of triggers and good and not so good times has been critical to my overall improvement. Knowing that the not so good times will have their place just as those times when I can catch up on all I wish to accomplish - indeed, respecting that the balance of life requires the down as well as the up - that makes a big difference. It was only a few short weeks ago that I was frankly contemplating the peace that the absolute end of my life would bring. It was this out of order (for me) thinking that alerted me that my medications were not working as well as they should have been. I'm not one who regularly thinks about ending my life, but between the pain and the depression it felt perfectly normal to be doing so. Normal, indeed.
So doing this transition from Pristiq to Cymbalta, during my vacation, wasn't the greatest of timing, but I wasn't able to reschedule the holiday; the medication change sure wouldn't be put off another moment. All in all it's gone relatively well.
pc
Posted by Conundrum on October 29, 2010, at 21:51:10
In reply to Re: pristiq to cymbalta? » floatingbridge, posted by PartlyCloudy on October 29, 2010, at 18:30:07
>
> I have always responded very positively, almost euphorically, to acupuncture.You know I tried acupuncture for depression and indigestion and while it didn't help, during that period, I would get this sensation of drifting off, almost like euphoria. Its very interesting. Unfortunately I didn't have any lasting effect.
Posted by floatingbridge on October 29, 2010, at 22:32:31
In reply to Re: pristiq to cymbalta?, posted by Conundrum on October 29, 2010, at 21:51:10
Conundrum, it can be very good support. Sounds like you're a responder. I like to go once a month when my budget allows. She knows about my meds et al, and never bugs me. When I regularly take the herbs she prescribes, they seem to tonify my stressed and whacked-out system.
Posted by Dr. Bob on November 2, 2010, at 21:37:33
In reply to Re: pristiq to cymbalta? » Phillipa, posted by floatingbridge on October 25, 2010, at 13:38:57
> I can't figure out how to change my signature!
See:
http://www.dr-bob.org/babble/faq.html#signature
Bob
Posted by PartlyCloudy on November 3, 2010, at 10:37:17
In reply to Re: pristiq to cymbalta? » floatingbridge, posted by PartlyCloudy on October 29, 2010, at 18:30:07
I had my follow up appointment with my pdoc today and we are going to stay with 30mg of Cymbalta as the therapeutic dosage, hurray! Also I'm able to use 15mg of Remeron prn at night for insomnia as needed, which is a huge psychological relief for me. It's almost as if I have this secret bullet for the odd time when the Seroquel doesn't overcome the daily accumulation of anxiety enough to allow me to sleep.
I'm a relatively happy camper, and my back is feeling much better.
PartlyCloudy
Posted by floatingbridge on November 3, 2010, at 11:44:05
In reply to Re: pristiq to cymbalta?, posted by PartlyCloudy on November 3, 2010, at 10:37:17
P/C,
So 30mg provides enough mood and pain relief? That is good news. I like having that 'emergency med', as I call it, for sleep. Have you used remeron before? I'm curious what the morning feels like. Sometimes sonata doesn't work, (every so often), so I'll take extra xanax. I'm not happy with that, and I don't feel so great in the morning.
I see my pdoc tomorrow, and we'll discuss cymbalta. I'll let you know.
I am so glad the cymbalta is working for you. Yay happy camper!
Posted by PartlyCloudy on November 3, 2010, at 11:56:46
In reply to good news Re: pristiq to cymbalta? » PartlyCloudy, posted by floatingbridge on November 3, 2010, at 11:44:05
I am "logey" in the morning with the Remeron but at 15mg the eat-everything-in-sight effect is not as bad and I still sleep solidly through the night. So a good compromise for me.
pc
Posted by floatingbridge on November 4, 2010, at 14:06:00
In reply to Re: how to change your signature, posted by Dr. Bob on November 2, 2010, at 21:37:33
> > I can't figure out how to change my signature!
>
> See:
>
> http://www.dr-bob.org/babble/faq.html#signature
>
> BobThanks, Bob.
Posted by Conundrum on November 7, 2010, at 14:29:26
In reply to good news Re: pristiq to cymbalta? » PartlyCloudy, posted by floatingbridge on November 3, 2010, at 11:44:05
Have you used remeron before? I'm curious what the morning feels like.
I take 60mgs and I don't feel tired or anything when I wake up. I specifically asked to start at 30mg so I wouldn't be so tired in the morning. I think the first two days I was logey but it was not that bad and then it went away fast. It will make you tired at night though.
30 mg remeron + cymbalta might have a good AD punch too.
Posted by floatingbridge on November 7, 2010, at 14:42:33
In reply to Re: good news Re: pristiq to cymbalta?, posted by Conundrum on November 7, 2010, at 14:29:26
Why thank you. I'll run that past my pdoc. I haven't tried it.
When would you take remeron? Morning or night?
Sounds like it could be a simple solution.
Posted by Conundrum on November 8, 2010, at 9:42:18
In reply to Re: good news Re: pristiq to cymbalta? » Conundrum, posted by floatingbridge on November 7, 2010, at 14:42:33
You would take it at night because it knocks you out. Weight gain is the thing to look out for with Remeron.
> Why thank you. I'll run that past my pdoc. I haven't tried it.
>
> When would you take remeron? Morning or night?
>
> Sounds like it could be a simple solution.
>
>
Posted by floatingbridge on November 8, 2010, at 10:29:04
In reply to Re: good news Re: pristiq to cymbalta? » floatingbridge, posted by Conundrum on November 8, 2010, at 9:42:18
Thanks Conundrum. Yeah, I've heard about the weight--pretty notorious. How has it been for you?
I figure, if I feel better, am more active, and generally am healthier.... Well, I'd hope it wasn't too much weight.
I'd love to switch out my sonata....
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