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Re: PDOC appointment Friday first time in years kadykat

Posted by phidippus on April 11, 2014, at 16:23:35

In reply to PDOC appointment Friday first time in years, posted by kadykat on April 10, 2014, at 1:07:56


> I am in pain management; therefore, the only psychiatric medication I take is duloxetine 60mg. I mean, I suppose I responded OK to it, for it to take me this long to get to this point.

If you feel you're only getting partial response to the Cymbalta, maybe its time to move on to another medication.

> I sleep anywhere from 12-16 hours a day. I am literally too tired to get out of bed.

I bet you'd do well on Nuvigil or Xyrem.

> I think it might be a good idea to double the Cymbalta to 120mg. and augment with an atypical antipsychotic?

I think this might be a good idea if you're bipolar, but you're not. I think Tramadol would be a better augmenter with the pain issues you have.

> I also think that Nuvigil (I think Focalin would be better but I take medication for high blood pressure) makes sense as well to combat my constant fatigue.

A better response to an antidepressant will help with the sleep issues, but if you're also fatigued, Nuvigil and Xyrem aren't bad options.

> I think I need something for my anxiety. Of course benzodiazepines pop up first, but I know about their reputation.

If the antidepressant isn't helping you 100% with your anxiety as well, its time to look at a different antidepressant.

> I'm not sure if I'd really like to even stay on Cymbalta.

Then try something else.

> I don't think the duloxetine helps my fibromyalgia.

I don't see how it would.

> I'm really liking the idea of the idea of this Latuda stuff more than anything I've read about about.

Get on a more effective antidepressant and you won't need Latuda.

> A good first visit?:
>
> Cymbalta 60mg. --> 20mg. titration downwards
> Lamictal titration
> Latuda 40mg.
> Nuvigil 150mg.

Stop Cymbalta
Start Mirtazapine 15mg
Start Nuvigil 150 mg
Start Tramadol XR 150 mg
Lamictal 50 mg

> Does anyone have any ideas?

Switch from Cymbalta to Mirtazapine, or something else. Start Tramadol. Start Lamictal. Start Nuvigil or Xyrem.

Eric


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