Posted by yznhymer on September 15, 2004, at 10:54:45
In reply to Re: Cymbalta (duloxetine) - report, posted by SLS on September 15, 2004, at 7:58:53
> 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.
>
>
> - ScottScott,
Thanks for the welcome! I appreciate your insights and encouraging words. I'm sort of in an interesting place dealing with this. In recent years I've just been grateful that the really black suicidal episodes have abated. I sort of settled into a chronic low level depressive state. Having exhausted the usual medication options I focused on making adjustments in my life to accomodate the new reality. I'm sort of waking up to the fact that I might be able to do better than this, although it is hard to imagine being as engaged in life as a lot of the people around me. Still, I think back to that course of Nardil... I felt solid and in touch with the best parts of myself. Nothing has ever worked that well before or since. I want that again. Anyway, I see some new medical options, and there are some lifestyle things I can re-embrace that might make a difference.
Regarding Nardil, I never made it as far as a 3 month trial to see if the sexual side effects would dissipate. The weight gain was so pronounced and so rapid (and so not good for my blood pressure) that it was clearly not going to be a suitable long-term therapy. And honestly, 3 months without the big O? How do people do that?
I'm guessing that when the pdoc and I meet, we'll prolly give Cymbalta a go first. Selegiline and parnate also remain options. I also had a pretty good response when I added DHEA and exercise to my moclobemide regimen. I think its worth seeing how restarting DHEA and exercise work out on their own.
By the way, I appreciate your caveats about this message board. I do find this a great place to pick up some new ideas, clarify my own thinking, and benefit from knowing I'm not the only one dealing with this. I take nothing as gospel, though the information people present here is a useful beginning for further investigation.
Best to you in the meantime (fingers still crossed for the success of your Cymbalta trial).
Mark
poster:yznhymer
thread:380308
URL: http://www.dr-bob.org/babble/20040915/msgs/391062.html