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Dr. Bob is Robert Hsiung, MD,
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Posted by utopizen on October 12, 2004, at 17:00:48
In reply to Re: Cymbalta, posted by invisiblemanpa on October 12, 2004, at 14:37:46
> Hey that's good to hear I just started Cymbalta today....depression and life long socail anxiety..Effexor almost put me under.........
> I was going to ask how it has been working for anxiety issues..of course the Lilly site can't list that yet.....but I am sure they will........my Psy doc promised it had excellent crossover benefits for anxiety........anyone have anything to add????????
> eIf your anxiety is unbearable after a month or so, ask your doc for some Klonopin as needed or regular dosing.
But regardles, I advise you should talk to your doc to agressively increase the dose to 60mg, and increase beyond that up to 120mg if 60mg after a few weeks isn't helping your depression or anxiety. It's important not to use benzos when you haven't given enough opportunity for an AD to work.
Posted by invisiblemanpa on October 12, 2004, at 17:51:49
In reply to Re: Cymbalta, posted by utopizen on October 12, 2004, at 17:00:48
Thanks for the suggestion. I already am using Klonopin with great success. It is a much smoother ride than Ativan or Xanax. I am at the point that I sometimes forget to take it, when with Ativan I was counting the hours . Yes my hope is that the crossover effects from Cymbalta really helps my SA. But I am not afraid to continue klonopin as long as I need to. I can honestly say that benzos are the only type of med that helped me tremendously. Yes, they can be addictive, but if it means being able to lead a semi normal lifestyle rather than becoming a recluse...I will stick with them for now. None of the AD that I have tried and that is about 6 have had any help with anxiety. But I have high hopes for Cymbalta, then using Klonopin as needed.
e
Posted by utopizen on October 12, 2004, at 22:36:19
In reply to Re: Cymbalta, posted by invisiblemanpa on October 12, 2004, at 17:51:49
Sorry- this is long-- but it's informative to ANYONE who wants to feel like they're getting the most out of their treatment, and advise anyone to read it.
--
You have a very healthy attitude about your treatment management. It's refreshing to hear-- so many of us (or at least me) often just treat these meds like they're band-aids for our brain.I'm trying to get away from this, and just scheduled my CBT appointment today and will start seeing this therapist regularly (biweekly) for the next few months.
I'm glad you find hope in Cymbalta. Don't be afraid to work with your doc to agressively up the dose-- just a few days of 30-40mg is all that is really needed before goign to the target dose of 60mg, IMHO through the literature I've read.
The 60mg dose should provide you with some relief after 1-2 weeks of being on it, and full relief at some time in the 4th week or slightly later. As always, it could take a couple of months before you notice a thing, even if you're only counting from the first day you began 60mg (the therapeutic dose).
But don't despair. You're on Klonopin already, which will help you chill while you wait for Cymbalta to do its thing. And even if the 60mg target dose doesn't spell relief after a month, keep in mind many do take up to 120mg, leaving you room for even further improvement and hope.
And of course, if you persist with your symptoms at a very high dose of Cymbalta, the usual augmenting meds are always available for you, with cheap co-pays. Lamictal, Lithium, and an atypical antipsychotic can really help depressives (bipolar or not) receive more relief when they only find partial relief from a single antidepressant. And if those fail, there's always Lexapro you can add on to the Cymbalta, and see how that goes. But all of these are just ideas, and I'm not a doc, I'm just going by common treatment-resistant treatment regimens that are published in psychiatric journals. Listen to your doc, not me.
The important thing is-- especially if you plan on a time where you reduce your Klonopin to prn (as needed) use- is to continue with Cognitive Behavioral Therapy.
But do keep in mind that some studies indicate antidepressants are sometimes aided by Klonopin use, although reports of depression also exist.
Don't expect Cymbalta to be a miracle-- you may find it will help somewhat, and Klonopin use isn't really anything to shy away from if you find it helps and aren't abusing it. It does have discontinuation issues, but this isn't much of an issue- if your doc has been practicing medicine at some point after 1957, he knows how to wean you off it without risking a seizure.
Klonopin, unlike Xanax, IS NOT physically addictive. It's only psychologically habit-forming, and being someone who took 1 mg 3x/day, I can tell you I also forgot doses now and then and never once felt any need to increase my dose beyond what was directed.
Cymbalta, and CBT, and exercise, and schedule-planning and other behavioral strategies, will help you. You sound like a very sound and grounded person, and there's no reason to think you won't find relief between your meds and therapy.
Just one thing, though- I advise everyone with depression/anxiety to make a log at least once a week, it doesn't need to take 2 minutes. List your major concerns/stresses, your mood on a scale of 1 to 10, and honestly ask yourself if you're doing what's necessary to control your stress and stay on task with your life. Work with your therapist on how to cope with things you feel are out of your "control," have your doc and therapist allowed to talk to one another, and arrange appointments regularly with each.
And I can't stress this enough: call your doc weekly, especially if you AREN'T noticing any progress. Yes, these meds take weeks, but they can be adjusted now and then to speed up your treatment. DON'T rely on meetings alone to confont your concerns. Call ahead a few days prior to each appointment tp leave a short message to your doctor and therapist listing your top concerns, ideas for med changes (if any) and explain whether you feel you are worsening, progressing, or staying the same.
If you meet monthly with your care provider, but feel you need more agressive management of your treatment, bring this up.
Ask if you can see your provider more frequently, or at the very least have brief phone updates each week and have your providers talk to one another between appointments. Especially if your pdoc won't agree to this simple request, ask if he can refer you to a colleague that will.
Waiting monthly just to add a little to your dose or something is wasting your appointments-- incremental dose adjustments should be handled in-between appointments unless you have weekly meetings.
Posted by invisiblemanpa on October 13, 2004, at 4:53:05
In reply to Re: Cymbalta, posted by utopizen on October 12, 2004, at 22:36:19
Thanks for the excellent advice, lots to think about. I am staying on the Remeron which was added to my cocktail in July, I will take back one comment about AD never helping me, after adding Remeron, three weeks later, I was actually laughting out loud, motivated, energized, just like someone reached inside and pulled out the old me.....but after some personal crisis....always ongoing for some of us...it seem to stop and the doc bumped the effexor back to 225, I had been as high as 300, and within days I hit an all time depressed state.....it was unbearable and I think if I had not started to wean myself off.....well things would of not been good..I keep in touch with my Psy doc and Therapist by writing to them....it has helped immensely over the past year in informing them, keeping the facts straight, and getting changes made..much better than the telephone.......anyone out there try it...great way to communicate.....just like email.......I have been talking to a great therapist and my minister over the past year on a regular basis and it has been a blessing to have someone other than family to confide in, they are both caring guys, with a sense of humor and knowledge and understanding, especially my Pastor as his family has dealt with depression on a personal level and I come to find out that I am not the only one in the congregation struggling, there are deacons and others...they are usually there and sometimes not....I was of course not told who they were, but it helps to know that I am not the only educated, professional person out there struggling with these issues......thanks again!
e
Posted by golfgirl74 on October 13, 2004, at 8:58:35
In reply to Re: Cymbalta » utopizen, posted by invisiblemanpa on October 13, 2004, at 4:53:05
day 4 on cymbalta. i have a terrible highway driving phobia. was able to drive to the shrink without having a full on panic attack. that's a miracle. it's gotta be the drug.
Posted by invisiblemanpa on October 13, 2004, at 10:35:24
In reply to Re: Cymbalta, posted by golfgirl74 on October 13, 2004, at 8:58:35
Hey hang in there! Maybe it is reaction, I think I saw anxiety etc. listed along with a multitude of other things to scare us with...many of them true for some I'm sure. How many mgs did they start you on?? I've started on 30 and so far so good. Are you on any benzo's. I think my Klonopin is helping with any possible beginning side effects as it helped me wean off the dreaded effexor xr......good luck. I am holding high hopes, cause if this one does not work, I am going natural or nothing at all.......
e
e
Posted by boomarang on October 13, 2004, at 11:40:32
In reply to Re: Cymbalta, posted by golfgirl74 on October 13, 2004, at 8:58:35
i know what you mean. i have a horrible elevator phobia and i was able to get on one over the weekend. road up three floors just fine. 40mgs cymbalta
Posted by golfgirl74 on October 14, 2004, at 8:42:09
In reply to Re: Cymbalta » golfgirl74, posted by boomarang on October 13, 2004, at 11:40:32
I'm on 60mg. This is only day 5 and this drug is a godsend to me. I'm not on anything else. It's definitely gotten rid of my anxiety and I'm not feeling desperate anymore.
Posted by invisiblemanpa on October 14, 2004, at 12:17:33
In reply to Re: Cymbalta, posted by golfgirl74 on October 14, 2004, at 8:42:09
Ah Bless You that is wonderful to hear. I am on day 3 at 30 mg and have had no side effects at all...I have high hopes to!
e
Posted by jboud24 on October 14, 2004, at 18:53:16
In reply to Re: Cymbalta, posted by invisiblemanpa on October 14, 2004, at 12:17:33
Questions for the Cybalta peeps:
1) What does Cymbalta subjectively feel like compared to a pure SSRI? I'm curious since I've never taken anything noradrenergic.
2) Does anyone find that on Cymbalta they dont get as daytime sleepy as with a pure SSRI?
3) Is anyone getting a better anti-anxiety response from Cymbalta than on other SSRI's?
Thanks in advance,
Justincurrently unhappy at zoloft 100mgs
Posted by utopizen on October 14, 2004, at 20:17:58
In reply to Re: Cymbalta, posted by jboud24 on October 14, 2004, at 18:53:16
> Thanks in advance,
> Justin
>
> currently unhappy at zoloft 100mgsJustin, I'm not a doc, but have used Zoloft before.
100mg is, according to my psychopharmacologist, "an incredibly low dose." It's a starting dose. It's nothing to feel like it's a dose to evaluate whether to continue on it or not. Some try 50mg-100mg mostly because they might be sensitive to meds.
You should call your doc immediately if you aren't noticing any progress. He/she can up your dose, call in your pharmacy for a higher dose, and maybe even add something to your cocktail now or down the road. Just don't wait until the next appt. to let your doc know you don't feel any progress has been made. That's not going to help you in any way.
The optimal dose-- not high dose-- just the one that many find helpful- is 200mg. In fact, Lexapro 10mg was compared by its maker to Zoloft 200mg. And Lexapro 10mg is just a small starting dose.
You should up your dose to 200mg, and wait a month, before adding or substituting the Zoloft. Otherwise, you could be missing out on a lost opportunity.
Hang in there. Whatever you do, DON'T WAIT until appointments to let docs knows you don't feel better- leave messages each week letting them know you continue to feel little/no progress. They sometimes use phones, and have been known to return calls at times. If I waited until each appointment to tell my doc my antidepressant wasn't working, I'd never have any hope at getting treated.
Posted by jboud24 on October 15, 2004, at 11:55:21
In reply to Re: Cymbalta » jboud24, posted by utopizen on October 14, 2004, at 20:17:58
I'm on the verge of seeing a new pdoc, but I wont see him until the 28th and I've never seen him yet before. In other words I dont have another doc right now.
In regard to the Zoloft though, I have been up to 300mgs with nothing but extra side effects and virtually complete anorgasmia. I've been on Zoloft for about 2 1/2 months now.
Thanks for the advice though, and I wish I did have a doc I could go to right now or call, but I just dont, and I won't have the money to see a new one until the end of the month.
Thanks,
Justin
Posted by invisiblemanpa on October 15, 2004, at 12:50:44
In reply to Re: Cymbalta, posted by jboud24 on October 15, 2004, at 11:55:21
That is one of the worst parts of facing mental health issues...getting in to see your Psy. doc when you don't have an appointment. Mine will return call if it is something serious, but getting an appointment is next to impossible. The psy doc I ever saw was booked four months in advance! Dang, think of all the money they are making off of us! As long as I have been dealing with my issues and finding out a lot more about others...jeez I could just puruse Dr. Bob's website, write out a script, my signature is illegable anyway...and bam..$150 minimum......seems like a great way to make a living and all the great perks from the pharm. reps......If I could just go back 20 years and change my major!
e
Posted by hope4best on October 16, 2004, at 10:16:01
In reply to Re: Cymbalta » jboud24, posted by utopizen on October 14, 2004, at 20:17:58
I've been taking Cymbalta 30 mg for about 2 weeks. At first felt awesome, yesterday and today kind of dragging. I want to increase to 60 mg. If I do should I take 30 in the am and 30 in the pm, or 2 30's at the same time?
Posted by earthgirl on October 16, 2004, at 11:13:19
In reply to How long should I wait to increase Cymbalta dose?, posted by hope4best on October 16, 2004, at 10:16:01
Dear Hope4Best,
30mgs of Cymbalta for 2 weeks sounds very conservative. The PI reads "40mg for one week, and 60mg thereafter." The PI states that you can take it all at once, or split it up, depending on your reaction. Personally, the Cymalta has a mild energizing effect on me, so I am taking 60mg all at once in the morning.
(I tried taking 1/2 in the AM and 1/2 in the PM, but I seemed to have trouble getting to sleep. So, I take it all in AM)
It's only Day 5 for me, but so far so good!
Earthgirl
Posted by invisiblemanpa on October 16, 2004, at 11:27:01
In reply to Re: How long should I wait to increase Cymbalta dose? » hope4best, posted by earthgirl on October 16, 2004, at 11:13:19
I am also on day five. I was given one week of 30mg samples, then two weeks at 60mg. So far so good! No side effects at all...I can remember what Paxil and Zoloft did to me when I tried them, down the toilet they went....I was crawling out of skin, a nervous wreck. This is a blessing. I have high hopes for all of us!
Posted by earthgirl on October 16, 2004, at 11:39:09
In reply to Re: Cymbalta, posted by jboud24 on October 14, 2004, at 18:53:16
Hi jboud24,
This is in response to your post "Questions for the Cymbalta peeps."
I was on Prozac (a pure SSRI) for 10 years, and I just spent 30 weaning off of it so I could have a somewhat clean start on Cymbalta
I am on Day 5 of Cymbalta; so, I will compare Day 5 Cymbalta with Day 5 Prozac (which I remember well!).
1. On Day 5 of Prozac I felt jittery, nervous, dry mouth, talkative, and I was clenching my teeth. Day 5 on Cymbalta I feel pleasantly and mildly energized, mentally focused, and very calm. I am having trouble going and staying asleep at night, and I also had this early on with Prozac-so they are the same that way.
2. I am not having trouble with daytime sleepiness on Cymbalta so far, and I did not have trouble with that on Prozac either.
3. Normally (without drugs:-), I have TERRIBLE anxiety/social anxiety. After about 3-4 months on Prozac I felt less social anxiety, but I still experienced a general anxiety. After just 5 days on Cymbalta, my social anxiety and overall anxiety feels non-existant!!
Okay, I'm comparing something I was on for 10 years, versus something I have only been on for 5 days... Obviously, I'm VERY hopeful about Cymbalta, but I also know it is early and anything could happen along the way.
This is just my experience so far. For what it is worth.
How is Zoloft treating you?
EG
Posted by earthgirl on October 16, 2004, at 11:44:43
In reply to Re: Cymbalta, posted by golfgirl74 on October 14, 2004, at 8:42:09
Golfgirl74,
I am with you all the way on the Cymbalta!
It is Day 5 for me and my anxiety has greatly diminished. I'm having a little trouble going to sleep and staying asleep, how is that going for you?Earthgirl
Posted by earthgirl on October 16, 2004, at 11:56:26
In reply to Re: Cymbalta, posted by utopizen on October 12, 2004, at 22:36:19
Utopizen,
Your experience and personal knowledge of meds is amazing!
How is your current cocktail treating you, and how long have you been on it?
Also, if it isn't too much trouble, would you be willing to share with us your med "story" or history?
Earthgirl
Posted by earthgirl on October 16, 2004, at 12:06:21
In reply to Re: Cymbalta, posted by invisiblemanpa on October 12, 2004, at 14:37:46
Invisiblemanpa,
Anxiety and social anxiety competely suck, don't they? I was trying to come up with a more sophisicated comment, but was at a loss... :-)
I am Day 5 Cymbalta and my anxiety and social anxiety are practically non-existant! Normally, those feelings are insidious and relenting for me.
So far, Cymbalta has worked like magic. But it is only the top of the first inning in the Cymbalta ballgame for me, so, I'll get back to you in the 7th inning stretch.
Earthgirl
Posted by invisiblemanpa on October 16, 2004, at 16:28:38
In reply to Re: Cymbalta » invisiblemanpa, posted by earthgirl on October 16, 2004, at 12:06:21
Earthgirl,
Yes "Suck" just abouts explains it to a T. And most people have no empathy or understanding unless they have been there. I think it is still to early for me to tell. I plan on trying to back off on the Klonopin and then try going to church etc. without taking it....then we shall see.......the true test for me is being put in a closed room with a group of people, especially if I have to get up and speak..when I am able to do that without any Benzo's then I will swear by Cymbalta......
e
Posted by hope4best on October 16, 2004, at 17:45:11
In reply to Re: Cymbalta » golfgirl74, posted by earthgirl on October 16, 2004, at 11:44:43
Hi, thanks for the dosing advice, I'm gonna increase to 60 tomorrow morning. I too have had trouble staying asleep...I wake up in the middle of the night and I feel wide awake, can't get back to sleep. Also, has anyone been experiencing sexual side effects with Cymbalta? Do they go away?
Posted by invisiblemanpa on October 16, 2004, at 18:10:27
In reply to Re: Cymbalta » earthgirl, posted by hope4best on October 16, 2004, at 17:45:11
That's a good question! Because they sure did on Effexor ...it all went away, dreams, ability, desire.....
e
Posted by Rayray on October 16, 2004, at 21:49:11
In reply to How long should I wait to increase Cymbalta dose?, posted by hope4best on October 16, 2004, at 10:16:01
My pdoc recommended twice a day dosing but said I could go with once a day if I wanted. I switched from 30 to 60 after one week with no ill effects. As a matter of fact, the few side effects I felt in week 1 were largely gone in week 2.
Good luck,
Ray
Posted by invisiblemanpa on October 17, 2004, at 2:44:41
In reply to Re: How long should I wait to increase Cymbalta dose? » hope4best, posted by Rayray on October 16, 2004, at 21:49:11
Ray,
Did you have any insomnia when switching to Cymbalta. I have switched from Effexor and the insomnia started about 2 plus weeks ago.....I am on day 6 of Cymbalta, but the insomnia sucks. I went for years battling insomnia a few years back it stopped when I tried my first AD, though that was the only benefit from it. I hope when the Cymbalta kicks in I get back into a normal sleep cycle.
Ed
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