Posted by SLS on September 15, 2004, at 7:58:53
In reply to Re: Cymbalta (duloxetine) - report, posted by yznhymer on September 15, 2004, at 4:02:09
Hi Mark.
Welcome to Psycho-Babble and thank you for the great introduction.
I agree with Irene in suggesting Parnate. Parnate is much less likely than Nardil to produce either weight gain or sexual dysfunction. If anything, you might experience an abnormal orgasm for the first few weeks, but it dissipates, and both erectile and orgasmic function are left intact. I would say that oral selegiline is likely to be a waste of time. The patch seems to be significantly more effective. Still, I would place Parnate higher on the list if you are willing to deal with the dietary restrictions.
Cymbalta might be a logical choice at this juncture. Only one person has reported anorgasmia so far of the 8 or so people taking it here on Psycho-Babble. It hasn't affected me in the slightest. The side effect profile for Cymbalta seems to be less pronounced than for Effexor. Weight gain doesn't yet seem to be an issue. If you want a better idea as to how Cymbalta treats people long-term, I'm afraid you'll have to speak to a clinical investigator or wait and watch.
Lamictal by itself rarely does the trick. Many people experience a transient improvement within the first few weeks at dosages as low as 50mg, only to find it fade over time. 200mg seems to be the average effective dosage for depression, but I doubt you will achieve full remission in the absence of another antidepressant medication. The rate at which one can increase the dosage of Lamictal to a therapeutic level is very slow. The gradual titration is necessary to prevent a serious adverse reaction that includes a rash. Steven's Johnson syndrome can be a consequence of too fast a titration. It might be as long as 6 weeks before you reach 200mg.
You must take any advice given here with a grain of salt; not so much because of any inaccuracies that might be stated, but because everyone reacts so differently to treatment. For instance, you might be one of the few people for whom Lamictal monotherapy might be effective.
By the way, although you might indeed have dysthymia, I wouldn't endorse a diagnosis based upon the absence of depressed mood or sadness. Loss of interest and motivation is an equally valid criterion. Depressed mood is not a feature of my condition, yet my depression is quite severe.
Good luck with your treatment. Given your robust response to Nardil, I'm sure you will find something else that will work. I should mention that many people who experience anorgasmia with Nardil in the beginning of treatment find that their ability to orgasm returns after 3 months.
- Scott
poster:SLS
thread:380308
URL: http://www.dr-bob.org/babble/20040915/msgs/391002.html