![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by cache-monkey on September 15, 2004, at 0:13:10
Hey all,
For much of my life I've had what I think is GAD. Depression has sort of come and gone, most likely dysthymia, or maybe long-wave cyclothemia. My way of dealing with the anxiety has been through getting hooked on things like food, video games, relationships, aimless (and sometimes pointed and obsessive) web cruising, and cigarettes. So maybe symptoms within the penumbra of OCD.
I'd like to stop smoking at some point, soon. (It really doesn't 'fit' with the generally healthy life I try to lead otherwise.) But every time I've tried to quit in the past, it's knocked me into deeper anxiety and brought the depression on. I see it now as essentially a form of self-medication. I've just been through a pretty bad depressive/obsessive episode precipitated by quitting smoking and some other stuff.
I'm currently on BuSpar at 10 mg/day and recently ended the process of tapering off Serzone. The Serzone experience was horrible for me, I have to say. But somehow going through that and coming off of the Serzone, combined with some other life changes, I'm feeling alright as far as my underlying mood. What's left behind is a bunch of ill-focused anxiety that can be either apprehension or excitement depending on my underlying mood. Needless to say I'm smoking again.
Right now, I don't feel like the BuSpar is taking all of the edge off the anxiety. I'm also interested in quitting smoking again and really worried about heading back into a depression.
I know that Wellbutrin is the only clinically-proven AD that helps for quitting smoking. I went on it a couple of years ago and managed to almost get there. But WB ended up making me more anxious and obsessive. I added Celexa to it, but got complete anorgasmia and ended up gaining about 15 pound in the first 3 months on it. But, with that combination, I felt really good, although maybe a little hypomanic at times.
Right now I'm thinking about what to do about my meds. The options I'm looking at are a) increasing my dose of BuSpar and b) adding on Cymbalta.
I'm having a lot of trouble making a decision here.
As far as BuSpar, I realize that I'm at a low dose and that it might be worthwhile to increase it to around 30 mg/day. A lot of people have posted some negative stuff about BuSpar's efficacy, which is making me a little leery. I'm wondering, though, are there any people with minor depression and anxiety who have had _positive_ experiences with BuSpar alone? Anybody try to quit smoking while just on BuSpar? Do you feel like it helped?
I'm a little hesitant to go on Cymbalta because I'm worried about side effects. So, I'd like to know if any of the folks on Cymbalta have anything to report about weight and sexual SEs. Also, for any smokers on Cymbalta: have you noticed any reduction in your cravings?
So, any info or experiences you can share would be much appreciated. Additional suggestions are always welcome.
peace,
cache-monkey
Posted by alesta on September 15, 2004, at 2:41:08
In reply to GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...?, posted by cache-monkey on September 15, 2004, at 0:13:10
hi, cache-monkey,:)
you said all suggestions welcome, so here goes.:)for help quitting smoking and for help with anxiety, i would recommend that you try l-theanine. vitamin world is a good brand and there's another one i know of but can't think of at the moment (many brands are low in purity--you have to really make sure you've got a good one). here is a link concerning l-theanine and reducing smoking:
http://appft1.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PG01&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.html&r=1&f=G&l=50&s1=%2220030003130%22.PGNR.&OS=DN/20030003130&RS=DN/20030003130it would be great for anxiety and help quitting smoking b/c it affects dopamine and gaba. why not give it shot? all you've got to lose is about $12.
of course, if you want to give the buspar and cymbalta a try, by all means go for it...i haven't heard great things about buspar overall, and cymbalta affects mostly norepinephrine and serotonin, right? (if i am incorrect and it affects dopamine substantially, too, someone please let me know!) that isn't going to help your cigarette cravings or your anxiety much. plus, if cymbalta is anything like effexor, you might have weight gain and other side effects (as you mentioned) and horrible withdrawal symptoms..something to consider. i'm not trying to scare anyone from taking effexor or cymbalta, but there are people who wish they had never taken effexor, so i'm just giving you a heads-up, just in case..plus, there are many other things to try, but i'll leave it at this for now..:)
all right, well, that's my 2 cents' worth..i won't be offended if you don't take my advice:)..good luck with whatever you decide to try! (i'm going to look up cymbalta and check on its influence on dopamine..if it does influence dopamine substantially, then that's a different story altogether!)
and thanks for the excellent sleep info in a previous thread..:)
take care!:)
amy
Posted by zeugma on September 15, 2004, at 4:39:47
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...? » cache-monkey, posted by alesta on September 15, 2004, at 2:41:08
hi,
Something else you might try is nortriptyline. It is the only AD besides Wellbutrin that has been clinically shown to aid in quitting smoking. It has few discontinuation or sexual side effects, and is lesss likely to cause anxiety than Wellbutrin. Also, in my experience, it goes well with Buspar.
-z
Posted by Sad Panda on September 15, 2004, at 4:45:25
In reply to GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...?, posted by cache-monkey on September 15, 2004, at 0:13:10
> Hey all,
>
> For much of my life I've had what I think is GAD. Depression has sort of come and gone, most likely dysthymia, or maybe long-wave cyclothemia. My way of dealing with the anxiety has been through getting hooked on things like food, video games, relationships, aimless (and sometimes pointed and obsessive) web cruising, and cigarettes. So maybe symptoms within the penumbra of OCD.
>
> I'd like to stop smoking at some point, soon. (It really doesn't 'fit' with the generally healthy life I try to lead otherwise.) But every time I've tried to quit in the past, it's knocked me into deeper anxiety and brought the depression on. I see it now as essentially a form of self-medication. I've just been through a pretty bad depressive/obsessive episode precipitated by quitting smoking and some other stuff.
>
> I'm currently on BuSpar at 10 mg/day and recently ended the process of tapering off Serzone. The Serzone experience was horrible for me, I have to say. But somehow going through that and coming off of the Serzone, combined with some other life changes, I'm feeling alright as far as my underlying mood. What's left behind is a bunch of ill-focused anxiety that can be either apprehension or excitement depending on my underlying mood. Needless to say I'm smoking again.
>
> Right now, I don't feel like the BuSpar is taking all of the edge off the anxiety. I'm also interested in quitting smoking again and really worried about heading back into a depression.
>
> I know that Wellbutrin is the only clinically-proven AD that helps for quitting smoking. I went on it a couple of years ago and managed to almost get there. But WB ended up making me more anxious and obsessive. I added Celexa to it, but got complete anorgasmia and ended up gaining about 15 pound in the first 3 months on it. But, with that combination, I felt really good, although maybe a little hypomanic at times.
>
> Right now I'm thinking about what to do about my meds. The options I'm looking at are a) increasing my dose of BuSpar and b) adding on Cymbalta.
>
> I'm having a lot of trouble making a decision here.
>
> As far as BuSpar, I realize that I'm at a low dose and that it might be worthwhile to increase it to around 30 mg/day. A lot of people have posted some negative stuff about BuSpar's efficacy, which is making me a little leery. I'm wondering, though, are there any people with minor depression and anxiety who have had _positive_ experiences with BuSpar alone? Anybody try to quit smoking while just on BuSpar? Do you feel like it helped?
>
> I'm a little hesitant to go on Cymbalta because I'm worried about side effects. So, I'd like to know if any of the folks on Cymbalta have anything to report about weight and sexual SEs. Also, for any smokers on Cymbalta: have you noticed any reduction in your cravings?
>
> So, any info or experiences you can share would be much appreciated. Additional suggestions are always welcome.
>
> peace,
> cache-monkey
>
>Hi There,
You sound a lot like me. I spend an excessive amount of time in front of my PC, love playing Q2 & Toontown online, love binge eating & I used to smoke two packs a day. Firstly, cigarettes, I had switched to illegal pure tobacco & made my own for about twelve months & then I quit from there with relative ease. I would bet money that the tobacco companies add something a little extra to make cigarettes extra addictive. Wellbutrin is said to have some affinity for nicotinic acetylcholine receptors & doubles your chances of quitting compared to nicotine gums & patches. I chewed nicotine gum for six months & thought it to be somewhat helpful.
For AD's besides SSRI's, I would recommend a trial of the older TCA's as you might find them easier to tolerate(regardless of what SSRI marketers will tell you). Nortriptyline is a good one to try & can be added to some SSRI's & might provide you with some good anxiety relief.
Cheers,
Paul.
Posted by King Vultan on September 15, 2004, at 10:20:08
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...?, posted by zeugma on September 15, 2004, at 4:39:47
> hi,
>
> Something else you might try is nortriptyline. It is the only AD besides Wellbutrin that has been clinically shown to aid in quitting smoking. It has few discontinuation or sexual side effects, and is lesss likely to cause anxiety than Wellbutrin. Also, in my experience, it goes well with Buspar.
>
> -z
I was also going to suggest nortriptyline for the same reasons, but I have no experience myself combining it with Buspar.Todd
Posted by cache-monkey on September 15, 2004, at 13:39:25
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...? » cache-monkey, posted by alesta on September 15, 2004, at 2:41:08
<< of course, if you want to give the buspar and cymbalta a try, by all means go for it...i haven't heard great things about buspar overall >>Thing about BuSpar is that I'm on a pretty low dose, so maybe it makes sense to go higher before trying anything else. There's some evidence that BuSpar in higher doses could benefit high-anxiety smokers in quitting.
<< and cymbalta affects mostly norepinephrine and serotonin, right? (if i am incorrect and it affects dopamine substantially, too, someone please let me know!) that isn't going to help your cigarette cravings or your anxiety much. >>
Well, according to the Cymbalta PI:
"Preclinical studies have shown that duloxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake and a less potent inhibitor of dopamine reuptake."
So it seems basically like Wellbutrin mixed with an SSRI.Also, in study published in the Journal of Neurochemistry, Prozac, Cymbalta and Buspar were administered to rats. When each was administered individually, this led to increases in dopamine (DA) and noradrenaline (NAD) for all three. Prozac and Cymbalta also increased serotonin (5-HT), while BuSpar lowered 5-HT.
When they administerd BuSpar along with Prozac or Cymbalta, it lead to even larger increases in DA and NAD (stronger for Cymbalta), with no change the increase in 5-HT.
So there might be something to be said for this combination...
<< plus, if cymbalta is anything like effexor, you might have weight gain and other side effects (as you mentioned) and horrible withdrawal symptoms..something to consider. i'm not trying to scare anyone from taking effexor or cymbalta, but there are people who wish they had never taken effexor, so i'm just giving you a heads-up, just in case..plus, there are many other things to try, but i'll leave it at this for now..:) >>
Yeah, so this is where it breaks down for me. The side effects are a real concern. (I'm less worried about withdrawal since I found out it's possible to divide the gelcaps.) Right now I actually feel alright and am managing to cope with the background anxiety. I am worried, though, that it's all going to come crashing down again at some point either because of a quit attempt for smoking or for no good reason.
I guess I don't have to do anything drastic right away, but in the mean time I'll look more into the l-theanine. Thanks for the info on that.
peace,
cache-monkey
Posted by cache-monkey on September 15, 2004, at 13:51:30
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...?, posted by King Vultan on September 15, 2004, at 10:20:08
> > hi,
> >
> > Something else you might try is nortriptyline. It is the only AD besides Wellbutrin that has been clinically shown to aid in quitting smoking. It has few discontinuation or sexual side effects, and is lesss likely to cause anxiety than Wellbutrin. Also, in my experience, it goes well with Buspar.
> >
> > -z
>
>
> I was also going to suggest nortriptyline for the same reasons, but I have no experience myself combining it with Buspar.
>
> ToddI do remember reading somewhere that nortriptyline might have efficacy in helping depressed smokers quit. But, I've been under the impression that the side effects are generally less benign for the TCAs than for the SSRIs, especially the cholinageric ones (sweating, constipation, dry mouth) and that there's also a potetial for weight gain.
I'd be interested in hearing more about your experiences with side effects and such...
Also, doesn't this require multiple dosing (e.g. 3-4 times per day)? I also read something recently about needing a blood test to check the level of the drug in your system. Does this have to do with CYP-2D6 deficiency or is it something else? Let me know if you have any info, please.Thanks,
cache-monkey
Posted by cache-monkey on September 15, 2004, at 13:59:39
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...? » cache-monkey, posted by Sad Panda on September 15, 2004, at 4:45:25
<< You sound a lot like me. I spend an excessive amount of time in front of my PC, love playing Q2 & Toontown online, love binge eating & I used to smoke two packs a day. Firstly, cigarettes, I had switched to illegal pure tobacco & made my own for about twelve months & then I quit from there with relative ease. I would bet money that the tobacco companies add something a little extra to make cigarettes extra addictive. >>I agree wholeheartedly about the additives in standard cigarettes making the cravings and addiction stronger. I think I read somewhere that there's a whole science to making the first puff as strong as possible. I think that part of the craving has to do with that spike you get when you first light up. I've actually switched to American Spirits and I find that my cravings are a little better since I started.
<< Wellbutrin is said to have some affinity for nicotinic acetylcholine receptors & doubles your chances of quitting compared to nicotine gums & patches.>>
Yeah, and it actually just about worked for me. Except that it made me more anxious and obsessive. :(
<< I chewed nicotine gum for six months & thought it to be somewhat helpful. >>
I tried the gum, but for me it was actually a lot worse than the patch. I felt like I was constantly in withdrawal and never got that spike at the beginning I was craving. It also started messing with my stomach.
<< For AD's besides SSRI's, I would recommend a trial of the older TCA's as you might find them easier to tolerate(regardless of what SSRI marketers will tell you). Nortriptyline is a good one to try & can be added to some SSRI's & might provide you with some good anxiety relief. >>
Did you follow this route along with the gum? Out of curiousity, were you successful in your quit attempt? Hope so!
peace,
cache-monkey
Posted by mattw84 on September 15, 2004, at 15:02:58
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...? » cache-monkey, posted by Sad Panda on September 15, 2004, at 4:45:25
Wellbutrin ALL THE WAY!! I have been quit for more than a month now, and truly NEVER crave, the first week was rough. Still no where near how bad it had been prior to trying w/ wellbutrin. It has increased my anxiety a little bit I believe, but nothing a little xanax or klono can't take care off. Best of luck ! May want to consider joining a quit support group like over at http://www.quitnet.com, helps a ton and it keeps track of progress, money saved, life saved, etc... It's hell at first buy joo can do it!!
Another great thing about Wellbutrin is if you slip and smoke, you get ZERO BUZZ whatsoever; so I would definately say that it mimics nicotine to some extent.
Matt
Posted by alesta on September 15, 2004, at 15:04:46
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...? » alesta, posted by cache-monkey on September 15, 2004, at 13:39:25
> Well, according to the Cymbalta PI:
> "Preclinical studies have shown that duloxetine is a potent inhibitor of neuronal serotonin and norepinephrine reuptake and a less potent inhibitor of dopamine reuptake."
> So it seems basically like Wellbutrin mixed with an SSRI.
>
> Also, in study published in the Journal of Neurochemistry, Prozac, Cymbalta and Buspar were administered to rats. When each was administered individually, this led to increases in dopamine (DA) and noradrenaline (NAD) for all three. >this study says that prozac *increases* dopamine! this contradicts everything i have read/know about ssris....it is pretty common knowledge that the SSRIs substantially *decrease* serotonin, which is why there is the anhedonia, sexual side effects, akathesia, etc., so i would not place any merit on what this study says, personally..
i looked into this, and in basically all the sources i've seen, they say that Cymbalta is a dual reuptake inhibitor of the neurotransmitters serotonin and norepinephrine only..plus there tend to be sexual side effects eith the cymbalta, indicating a *lowering* of dopamine..so if there is some kind of slight dopamine agonist action in cymbalta, then it is counteracted by the serotonin agonist, so that there is no net increase of dopamine, probably...
hope something works for you..i'm not asking you to do anything drastic at all..do try the buspar at a higher dosage if you like..i was just giving you my thoughts and observations on each of these options, as you requested, and throwing some ideas out there for you, as well as are the others here...
good luck,
amy
Posted by cache-monkey on September 15, 2004, at 15:22:15
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...? » cache-monkey, posted by alesta on September 15, 2004, at 15:04:46
<< this study says that prozac *increases* dopamine! this contradicts everything i have read/know about ssris....it is pretty common knowledge that the SSRIs substantially *decrease* serotonin, which is why there is the anhedonia, sexual side effects, akathesia, etc., so i would not place any merit on what this study says, personally.. >>
It turns out that Prozac is a little different than the other SSRIs in terms of how it affects dopamine and norepinephrine. According to another study published in Psychopharmacology (link to abstract below):
"Fluoxetine, citalopram, fluvoxamine, paroxetine and sertraline similarly increased the extracellular concentrations of serotonin from 2- to 4-fold above baseline. However, only fluoxetine produced robust and sustained increases in extracellular concentrations of norepinephrine and dopamine after acute systemic administration. ... Amongst the SSRIs examined, only fluoxetine acutely increases extracellular concentrations of norepinephrine and dopamine as well as serotonin in prefrontal cortex, suggesting that fluoxetine is an atypical SSRI."
[ Abstract at
http://www.biopsychiatry.com/fluoxdopnor.htm ]Of course, this study (as well as the one I mentioned earlier) was undertaken using rats rather than humans. The in vivo properties might be different for humans...
<< hope something works for you..i'm not asking you to do anything drastic at all..do try the buspar at a higher dosage if you like..i was just giving you my thoughts and observations on each of these options, as you requested, and throwing some ideas out there for you, as well as are the others here... >>
Oh, I wasn't trying to imply that anyone was suggesting I do something drastic. I guess that for me I have some apprehension with respect going on Cymbalta. So, even though I mentioned it as something I'm considering, I still see it as a little bit more drastic than upping the BuSpar.
Thanks for the input!
cache-monkey
Posted by alesta on September 15, 2004, at 15:25:29
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...? » cache-monkey, posted by alesta on September 15, 2004, at 15:04:46
> this study says that prozac *increases* dopamine! this contradicts everything i have read/know about ssris....it is pretty common knowledge that the SSRIs substantially *decrease* serotonin
sorry, i meant to say that the SSRIs substantially decrease dopamine, not serotonin.:)
Posted by alesta on September 15, 2004, at 17:41:48
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...? » alesta, posted by cache-monkey on September 15, 2004, at 15:22:15
hey, c-m,:)
> It turns out that Prozac is a little different than the other SSRIs in terms of how it affects dopamine and norepinephrine. According to another study published in Psychopharmacology (link to abstract below):
> "Fluoxetine, citalopram, fluvoxamine, paroxetine and sertraline similarly increased the extracellular concentrations of serotonin from 2- to 4-fold above baseline. However, only fluoxetine produced robust and sustained increases in extracellular concentrations of norepinephrine and dopamine after acute systemic administration. ... Amongst the SSRIs examined, only fluoxetine acutely increases extracellular concentrations of norepinephrine and dopamine as well as serotonin in prefrontal cortex, suggesting that fluoxetine is an atypical SSRI."
> [ Abstract at
> http://www.biopsychiatry.com/fluoxdopnor.htm ]
>
> Of course, this study (as well as the one I mentioned earlier) was undertaken using rats rather than humans. The in vivo properties might be different for humans...interesting. i've taken prozac and can tell you from personal experience that my dopamine levels dropped drastically..i experienced all the symptoms i mentioned..anhedonia, akathesia, sexual side effects, etc. these side effects were extreme and pronounced for me and very unpleasant..i do wonder about some of these studies..hmm..but thanks for sharing.:)
> Oh, I wasn't trying to imply that anyone was suggesting I do something drastic. I guess that for me I have some apprehension with respect going on Cymbalta. So, even though I mentioned it as something I'm considering, I still see it as a little bit more drastic than upping the BuSpar.sorry..:)..i'm a bit oversensitive right now due to catastrophic life events:) i didn't mean to get attitudinal on you.:):)..i wish you luck!
take care,:)
amy
Posted by thinkfast on September 15, 2004, at 18:06:13
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...? » alesta, posted by cache-monkey on September 15, 2004, at 13:39:25
Wellbutrin seems to actually work on ciggarette cravings for me, but I felt like crap. From my trial with the Well., I decided that I needed to get rid of a lot of my anxiety before I decided to quit smoking. If smoking is completely related to your anxiety, I would work to deminish that first and not beat yourself up for smoking until you are calm enough to put all of your effort into quitting..I've given up quitting until that happens for me... that's my $0.02...good luck!
Posted by alesta on September 15, 2004, at 18:16:08
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...?, posted by thinkfast on September 15, 2004, at 18:06:13
sounds like good advice, thinkfast, from someone who's been there..if he can tolerate it, i agree with you guys, wellbutrin does sound like the ticket for quitting smoking..
amy:)
Posted by zeugma on September 15, 2004, at 19:04:47
In reply to Re: GAD/Dysthymia/Smoking: Pamelor/Nortriptyline, posted by cache-monkey on September 15, 2004, at 13:51:30
> > > hi,
> > >
> > > Something else you might try is nortriptyline. It is the only AD besides Wellbutrin that has been clinically shown to aid in quitting smoking. It has few discontinuation or sexual side effects, and is lesss likely to cause anxiety than Wellbutrin. Also, in my experience, it goes well with Buspar.
> > >
> > > -z
> >
> >
> > I was also going to suggest nortriptyline for the same reasons, but I have no experience myself combining it with Buspar.
> >
> > Todd
>
> I do remember reading somewhere that nortriptyline might have efficacy in helping depressed smokers quit. But, I've been under the impression that the side effects are generally less benign for the TCAs than for the SSRIs, especially the cholinageric ones (sweating, constipation, dry mouth) and that there's also a potetial for weight gain.
>
> I'd be interested in hearing more about your experiences with side effects and such...
>
>
> Also, doesn't this require multiple dosing (e.g. 3-4 times per day)? I also read something recently about needing a blood test to check the level of the drug in your system. Does this have to do with CYP-2D6 deficiency or is it something else? Let me know if you have any info, please.
>
> Thanks,
> cache-monkey
>
Hi.I have considerable experience with nortriptyline, as I've been on it for longer than all other meds combined. It has a long half life (average half life 18-32 hrs. depending on which source you read) so you don't have to worry about multiple dosing during the day. Generally it's taken at night as most find it sedating. The side effects? yes, they can be annoying: dry mouth, constipation, and drowsiness are among the most common. The drowsiness tends to pass but the dry mouth and constipation may require increased dental hygiene and regular intake of fiber pills.
the CYP-2D6 issues are also important. Essentially if you are a rapid metabolizer you will require a higher dosage but ironically, fewer side effects. This is because nortriptyline's metabolites have fewer s/e than the parent drug but equal efficacy. If you are a slow metabolizer you will need a lower dosage and be at risk for increased s/e. Doctors generally quiz you on what s/e you are experiencing as a rough guage of your status, and it's also important to have your bp monitored as it can cause tachycardia or hypotension. These things are a matter of course for treatment with any TCA.
-z
Posted by alesta on September 15, 2004, at 20:22:22
In reply to Re: GAD/Dysthymia/Smoking: Pamelor/Nortriptyline » cache-monkey, posted by zeugma on September 15, 2004, at 19:04:47
Posted by cache-monkey on September 15, 2004, at 23:07:58
In reply to Re: GAD/Dysthymia/Smoking: Pamelor/Nortriptyline » cache-monkey, posted by zeugma on September 15, 2004, at 19:04:47
<< I have considerable experience with nortriptyline, as I've been on it for longer than all other meds combined. It has a long half life (average half life 18-32 hrs. depending on which source you read) so you don't have to worry about multiple dosing during the day. Generally it's taken at night as most find it sedating. The side effects? yes, they can be annoying: dry mouth, constipation, and drowsiness are among the most common. The drowsiness tends to pass but the dry mouth and constipation may require increased dental hygiene and regular intake of fiber pills.
the CYP-2D6 issues are also important. Essentially if you are a rapid metabolizer you will require a higher dosage but ironically, fewer side effects. This is because nortriptyline's metabolites have fewer s/e than the parent drug but equal efficacy. If you are a slow metabolizer you will need a lower dosage and be at risk for increased s/e. Doctors generally quiz you on what s/e you are experiencing as a rough guage of your status, and it's also important to have your bp monitored as it can cause tachycardia or hypotension. These things are a matter of course for treatment with any TCA. >>
Hey,
It's good to know about the relative side effects between nortriptyline and its metabolites. The dry mouth is a particular concern for me, since my gums might be receding in a couple of places.
I have reason to think that I'm a poor CYP-2D6 metabolizer. I had a really bad experience on Serzone, hugely increased anxiety to the point of consistently being near panic, and a complete lack of appetite. This is consistent with the effects of the nefazodone metabolyte MCPP, which can build up to significant levels for those who are 2D6 deficient. (MCPP accumulation also helps explain the one positive of Serzone: increased libido and sexual function.)
I'm actually getting a blood test done to determine my genetic 2D6 capacity. These seem to have recently come available and are covered by my insurance. I'll see how that goes, but in the mean time Pamelor might not be the way to go for me.
Thanks for the info! It's been really helpful.
peace,
cache-monkey
Posted by Sad Panda on September 16, 2004, at 4:05:46
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...? » Sad Panda, posted by cache-monkey on September 15, 2004, at 13:59:39
>
> << You sound a lot like me. I spend an excessive amount of time in front of my PC, love playing Q2 & Toontown online, love binge eating & I used to smoke two packs a day. Firstly, cigarettes, I had switched to illegal pure tobacco & made my own for about twelve months & then I quit from there with relative ease. I would bet money that the tobacco companies add something a little extra to make cigarettes extra addictive. >>
>
> I agree wholeheartedly about the additives in standard cigarettes making the cravings and addiction stronger. I think I read somewhere that there's a whole science to making the first puff as strong as possible. I think that part of the craving has to do with that spike you get when you first light up. I've actually switched to American Spirits and I find that my cravings are a little better since I started.
>
> << Wellbutrin is said to have some affinity for nicotinic acetylcholine receptors & doubles your chances of quitting compared to nicotine gums & patches.>>
>
> Yeah, and it actually just about worked for me. Except that it made me more anxious and obsessive. :(
>
> << I chewed nicotine gum for six months & thought it to be somewhat helpful. >>
>
> I tried the gum, but for me it was actually a lot worse than the patch. I felt like I was constantly in withdrawal and never got that spike at the beginning I was craving. It also started messing with my stomach.
>
> << For AD's besides SSRI's, I would recommend a trial of the older TCA's as you might find them easier to tolerate(regardless of what SSRI marketers will tell you). Nortriptyline is a good one to try & can be added to some SSRI's & might provide you with some good anxiety relief. >>
>
> Did you follow this route along with the gum? Out of curiousity, were you successful in your quit attempt? Hope so!
>
> peace,
> cache-monkey
>
>I've been smoke free for more than 3 years.
The TCA side effects can actually be less than that of SSRI's, you have to try them to find out. Nortriptyline is good to try for anxiety & blood tests are valuable.
Cheers,
Paul.
Posted by jrbecker on September 16, 2004, at 10:32:17
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...? » cache-monkey, posted by alesta on September 15, 2004, at 15:04:46
> > Also, in study published in the Journal of Neurochemistry, Prozac, Cymbalta and Buspar were administered to rats. When each was administered individually, this led to increases in dopamine (DA) and noradrenaline (NAD) for all three. >
>
> this study says that prozac *increases* dopamine! this contradicts everything i have read/know about ssris....it is pretty common knowledge that the SSRIs substantially *decrease* serotonin, which is why there is the anhedonia, sexual side effects, akathesia, etc., so i would not place any merit on what this study says, personally..
>
> i looked into this, and in basically all the sources i've seen, they say that Cymbalta is a dual reuptake inhibitor of the neurotransmitters serotonin and norepinephrine only..plus there tend to be sexual side effects eith the cymbalta, indicating a *lowering* of dopamine..so if there is some kind of slight dopamine agonist action in cymbalta, then it is counteracted by the serotonin agonist, so that there is no net increase of dopamine, probably...
>>
> good luck,
> amyby antagonizing the 5-HTC receptor, prozac (fluoxetine) does increase prefrontal DA.
cymbalta (duloxetine) does slightly increase DA as well since DA has a slight binding affinity with NE receptors.
Posted by alesta on September 16, 2004, at 12:29:14
In reply to Re: GAD/Dysthymia/Smoking: Buspar (or Cymbalta or ...? » alesta, posted by jrbecker on September 16, 2004, at 10:32:17
hi, jr,
i honestly don't understand some of these studies indicating this information. it contradicts a lot of info i have read that says that SSRIs do indeed deplete dopamine. as well as my personal side effects i experienced indicating dopamine depletion as well. like i have said, this is *common knowledge*. JR, are you saying that the anhedonia, sexual side effects, and akathesia that result from taking SSRIs are not due to dopamine depletion???amy
This is the end of the thread.
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