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Re: Cymbalta - looking for information frombe

Posted by Racer on October 22, 2004, at 11:00:01

In reply to Cymbalta - looking for information, posted by frombe on October 22, 2004, at 2:57:45

First of all, you're absolutely right to be skeptical about the various websites out there. Congratulations for being much more sophisticated than many people, and for using your critical reasoning skills. Those are things that really matter to me.

This site, too, has a bias, since many of us are here because we've had a hard time finding a medication that works for us. Many of us are seriously treatment resistant, which skews the results a good deal.

Now on to your question:

Lexapro is a selective serotonin reuptake inhibitor. That means that it stops serotonin from being reabsorbed once its delivered its message to a receptor at a synapse. So, you have more serotonin floating around in your synapses, in both your brain and your digestive tract.

Cymbalta is a selective serotonin and norepinephrine reuptake inhibitor. Now you've got more norepinephrine to keep that serotonin company in the synapses. For many people, the addition of norepinephrine will make a huge difference in response to a medication. Serotonin alone is not the philosopher's stone of depression treatment, but most of the SSRIs are selective enough that it would have to be for them to work for everyone.

The oldest antidepressants, the MAOIs and the tricyclics, were not selective, and they hit all the monoamines: serotonin, norepinephrine, and dopamine. (I think some of them affected other chemicals, too, but am pretty ignorant about these things.) Those drugs worked pretty darn well for most of the people who took them, but they came with a pretty high price in terms of side effects. Some of them have a pretty narrow therapeutic window, with dangers like cardiotoxicity once you exceed the top of the range; others, like MAOIs, require major adjustments to lifestyle and diet to avoid serious adverse effects; and most had side effects like dry mouth, constipation, and weight gain. The newer drugs are more or less equally effective, statistically, but have far fewer and more benign side effects.

Cymbalta, which I've been taking for the past two months, is probably the most benign of the antidepressants I've taken personally, although I've been having two problems with it. I'm on a high dose, 90mgs, and I've had trouble with antidepressants of all sorts in the past. At the high dose I'm on, I'm tired all the time, not sleeping well, and it's not doing much for my depression. That's me, and it's similar to what I experienced on a very similar drug, Effexor. Of the two, Cymbalta is a much, much smoother ride than Effexor was for me: none of the major adjustment effects that I had with Effexor at first. I strongly suspect that it's a very good antidepressant, even if it's not working very well for me.

One benefit of Cymbalta, by the way, is the fact that it was held up in the approval process at the FDA for an extended period while the whole "SSRI-suicide" stuff was being reviewed. That means that it's been studied in a lot more depth and breadth than most. Some of the studies were for extended periods, which is very unusual for antidepressants, and it means that there are very few surprises to it. Also, it is good for chronic pain -- I can attest to that, since my arthritis is much less bothersome than usual at this time of year.

So, for what it's worth, I think Cymbalta is a good choice for a trial. Give it a go, and see what happens. You may find that it'll give you a good ride, and you may find that you're much more aware of depression once it lifts! Good luck, and be well.




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