![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 33. Go back in thread:
Posted by Minnie-Haha on February 27, 2005, at 19:16:00
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep, posted by Minnie-Haha on February 27, 2005, at 19:15:14
> My DXs are mild BP2 and mild OCD. Just on managing my anxiety and depression alone, I'd rate Cymbalta a 9...
I also take Trileptal.
Posted by qbsbrown on February 27, 2005, at 19:19:51
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep, posted by Minnie-Haha on February 27, 2005, at 19:15:14
i need help. Every SSRI or ssnri sends me through the roof. Get extremely irritated, memory, worse anxiety and depression. Even if i up my klonopin a little it still remains.
SO i end up quittin them w/in a couple days.
I've done cymbalta for 4 days, and got the same effects, and quit it two days ago.
Is there anything i could other than starting slow?
Im pretty much giving up on the ADs, as they make me worse. Tried every one during the past 3 years, and they all throw me in a bad spiral.
The only one that lifted my depression, was lamictal, but it caused horrible headaches.dx is gad, panic disorder, depression, and had bad depersonalization
ANy suggestions?
Regards,
Brian
Posted by Phillipa on February 27, 2005, at 19:28:37
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep, posted by qbsbrown on February 27, 2005, at 19:19:51
Brian, the same thing happened everytime I tried one until I went through menopause. Now nothing touches me. I'm beginning to think that I'm not depressed, but just bored. I can't even have a panic attack anymore. Fondly, Phillipa
Posted by Bill LL on February 28, 2005, at 8:35:32
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep, posted by Phillipa on February 24, 2005, at 17:58:39
I would give it a 9 (I take 60 mg). I am still waiting to see if it elevates my bp. I think it will due to the norepinephrine effect. If it does, I might switch my blood pressure meds to a beta blocker such as propranolol.
Posted by tygereyes on February 28, 2005, at 15:22:35
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep, posted by Bill LL on February 28, 2005, at 8:35:32
I'd give it a 1. It did nothing for me except prevent me from having orgasms.
Posted by Minnie-Haha on February 28, 2005, at 17:10:16
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep, posted by qbsbrown on February 27, 2005, at 19:19:51
> i need help. Every SSRI or ssnri sends me through the roof. Get extremely irritated, memory, worse anxiety and depression. Even if i up my klonopin a little it still remains.
> SO i end up quittin them w/in a couple days.
> I've done cymbalta for 4 days, and got the same effects, and quit it two days ago.
> Is there anything i could other than starting slow?
> Im pretty much giving up on the ADs, as they make me worse. Tried every one during the past 3 years, and they all throw me in a bad spiral.
> The only one that lifted my depression, was lamictal, but it caused horrible headaches.
>
> dx is gad, panic disorder, depression, and had bad depersonalizationYour DXs and experiences are outside my experience. I am mild BP2 and mild OCD, and SSRIs and SSNRIs work OK for me, as long as I take them with a mood stabilizer. (My MS of choice right now is Trileptal.) As for other ADs, many here swear by the TCAs and MAOIs. I hope you'll get feedback from others whose DXs and experiences are closer to your own. Maybe you'll need to start another thread, as this one started about Cymbalta? Good luck!
Posted by gadman on March 3, 2005, at 9:51:09
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep, posted by Minnie-Haha on February 28, 2005, at 17:10:16
I would give it a 5. Increased my BP and didn't help nearly as well as Effexor.
Posted by Aniadouble on March 3, 2005, at 10:48:52
In reply to CYMBALTA ratings 1-10, and effects on anx and dep, posted by qbsbrown on February 24, 2005, at 16:52:07
I've been on Cymbalta for about 10 weeks with no significant improvement for depression (I have no anxiety).
I've gained weight and still feel tired and unmotivated. I switched from Zoloft 150 mg & Welbutrin 300mg . Hoped that it would get better, but no.I'd give it a 3.
Posted by musicmaker on March 8, 2005, at 16:57:11
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep » qbsbrown, posted by Phillipa on February 27, 2005, at 19:28:37
I give Cymbalta a 10+
I've been from Prozac-Zoloft-Wellbutrin-Lexapro-Effexor and now finally Cymbalta with Klonopin as needed.
I hated Effexor but my sister has had a wonderful experience with it. She doesn't have as much of an anxiety problem though.
Posted by Mildred on March 8, 2005, at 17:07:55
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep, posted by musicmaker on March 8, 2005, at 16:57:11
> I give Cymbalta a 10+
> I've been from Prozac-Zoloft-Wellbutrin-Lexapro-Effexor and now finally Cymbalta with Klonopin as needed.What a great rating! Just wondering - have you had any weight gain or other side effects?
Posted by Steve3211 on March 11, 2005, at 16:06:01
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep, posted by Bill LL on February 28, 2005, at 8:35:32
Bill,
Weren't you on lex before? Why the switch?
Best - Steve
Posted by barbaracat on March 25, 2005, at 13:31:52
In reply to CYMBALTA ratings 1-10, and effects on anx and dep, posted by qbsbrown on February 24, 2005, at 16:52:07
After 6 weeks, I give it a 9. I'm only on 13 pellets out of a 30mg capsule. Stuff is potent. I'm also BP and can't take the usual SSRIs so this is a miracle for me. At this small dose along with lithium 600mg and benzos as needed, I'm doing better than I have in years. God willing it keeps up. - Barbara
p.s. How do you guys manage with 60mg? On 30mg I was bug-eyed and crawling on the ceiling.
Posted by Cindy Lou on March 27, 2005, at 14:51:52
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep, posted by barbaracat on March 25, 2005, at 13:31:52
Hello,
I haven't posted here for awhile ... I could really use some advice.I just started Cymbalta 4 days ago. They told me the lowest dose is 20 mg., however the side effects have been so bad for me I have to stop -- which is frustrating because I KNOW it was working for me emotionally (no anxiety attacks at all). I have also been diagnosed with BPII, depression and anxiety.
You mentioned you were taking 13 pellets out of a 30 mg. capsule -- did your pdoc suggest this? I asked the pharmacist if I could open the capsule and dump some out, and he said no, it would cause stomach upset without the enteric coating. (I was nauseous WITH the coating anyway.) Do you think I should just go ahead and try it? Most docs I know wouldn't be so open-minded.
You are giving me great hope here. I am very med sensitive and have had my heart broken many times on meds that seem to help but I can't tolerate the side effects.
I look forward to hearing back from you, and anyone else with this experience.
(I wasn't able to read through the whole thread -- sorry if I am asking for repeat info.)
Thank you!!!!
cindy
> After 6 weeks, I give it a 9. I'm only on 13 pellets out of a 30mg capsule. Stuff is potent. I'm also BP and can't take the usual SSRIs so this is a miracle for me. At this small dose along with lithium 600mg and benzos as needed, I'm doing better than I have in years. God willing it keeps up. - Barbara
>
> p.s. How do you guys manage with 60mg? On 30mg I was bug-eyed and crawling on the ceiling.
Posted by Phillipa on March 27, 2005, at 15:20:00
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep » barbaracat, posted by Cindy Lou on March 27, 2005, at 14:51:52
I did this too after reading it on Babble to wean off the medication. I put the crystals in a capsule I got from emptying out a vitamin I wasn't using anymore. From what Babblers are saying cymbalta seems to work well for BP11 in small doses. I'm sure someone will pop in and give you a more complete answer than I am. I was told the crystals are what's enteric coated. That you could mix it in yogurt or something and take it and it would still not dissolve in your stomach. I could be wrong though. Yeah, my pdoc thought I was crazy. Fondly, Phillipa
Posted by barbaracat on March 27, 2005, at 17:36:17
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep » barbaracat, posted by Cindy Lou on March 27, 2005, at 14:51:52
Hi Cindy,
First of all, here's a link to a currently running thread that goes into more detail and instructios on low dose Cymbalta, but I'm glad to answer your other concerns.
http://www.dr-bob.org/babble/20050322/msgs/475145.html;
> I just started Cymbalta 4 days ago. They told me the lowest dose is 20 mg., however the side effects have been so bad for me I have to stop -- which is frustrating because I KNOW it was working for me emotionally (no anxiety attacks at all). I have also been diagnosed with BPII, depression and anxiety.
**Doses come in 20, 30 and 60mg capsules - too high for most bipolars although some unipolar depressives start with 60mg (can't imagine it).
>
> You mentioned you were taking 13 pellets out of a 30 mg. capsule -- did your pdoc suggest this?**Hell, no. She's just as amazed as I am.
>>I asked the pharmacist if I could open the capsule and dump some out, and he said no, it would cause stomach upset without the enteric coating.
**I'm afraid your pharmacist if wrong. It's not the capsule that's enterically coated, it's each pellet, pretty amazing when you consider their size. I was vomiting for the first week on 30mg, which doesn't say much for their enteric coating.
>>Do you think I should just go ahead and try it? Most docs I know wouldn't be so open-minded.
**This is something you'll have to run through your own knowing and then decide for yourself but don't expect the blessing or guidance of your doc. He/she ought to be interested, but at this point it's a rare protocol and they have nothing to go on. The only encouraging thing you might hear is that at least you're not increasing the dose.
Unfortunately, the bulk of their education, research, grant and hospital money is heavily funded by pharmaceutical companies. Doctors have very little else to go on besides info from their drug reps or clinical stuties performed by drug funded research. They also worry about malpractice suits, etc.
My doctor said that Lilly is heavily promoting Cymbalta right now. She said that the drug rep never once mentioned potential bipolar switching being 'any worse than with the normal SSRI meds' and 20 is a 'substandard dose'. What we're seeing here is the evoluation of how a potentially good drug goes from promosing to dumped because not everyone is the same.
Even my doctor is tentatively happy that I'm responding so well, she's reluctant to suggest this 'not-standard' protocol with any of her other patients, even though EVERY ONE of them is having a terrible time with Cymbalta. She has no 'reputable source' other than my experience and if someone gets worse then it's her fault. A shame all ways around.
As far as I know I'm the only one tracking this, although others are giving me very positive reports. I have some scientific background so I'm not running blind, but this came about through necessity and not any random science project.
What I'm saying is that you'll have to think for yourself on this one and expect you'll be the one forging the way for your doc. So, Cindy, if it were me, I would stop taking that 20mg pill today, instead empty out the capsule and start with 3 pellets for about a week and then take another pellet each 3 days, seeing how you're feeling each time.
> You are giving me great hope here. I am very med sensitive and have had my heart broken many times on meds that seem to help but I can't tolerate the side effects.
>
** I wish you the hope-filled experience I continue to enjoy. But if it isn't the answer, don't give up hope. There's so much going on, so many variables. Hopefully you're in the same group I am in this regard. Hopefully our docs can get with the proram alot better, but their problems are not ours and in the meantime, at the very least we have to do something if we're getting worse. - Barbara
Posted by Cindy Lou on March 27, 2005, at 18:05:47
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep » Cindy Lou, posted by barbaracat on March 27, 2005, at 17:36:17
Dear Barbara, Phillipa too ...
Thank you, thank you, thank you! You have helped me tremendously. I appreciate the time you spent answering my questions and how quickly you replied. I am hopeful and ready to try the 3 pellets! I know this medication could really help me -- it was amazing the difference it made in just a few days (aside from the physical side effects, of course.)
I did not take any yesterday, and still I was so sick I could barely make it though the day. I had to go to bed at 8, then wake up at midnight to be the "bunny." Today I still felt sick -- nauseous, exhausted, spacy, heavy headed. Also depressed, because I felt another hope was lost. I am glad that all may not be lost.
Thanks again. I will read the link you sent me --I wasn't able to access it, but I'm sure I can find it through a search.
I will let you know how things go, and keep an eye out to see how you other Cymbalta-users are doing.
Take care,
cindy> Hi Cindy,
>
> First of all, here's a link to a currently running thread that goes into more detail and instructios on low dose Cymbalta, but I'm glad to answer your other concerns.
>
> http://www.dr-bob.org/babble/20050322/msgs/475145.html>;
>
> > I just started Cymbalta 4 days ago. They told me the lowest dose is 20 mg., however the side effects have been so bad for me I have to stop -- which is frustrating because I KNOW it was working for me emotionally (no anxiety attacks at all). I have also been diagnosed with BPII, depression and anxiety.
>
> **Doses come in 20, 30 and 60mg capsules - too high for most bipolars although some unipolar depressives start with 60mg (can't imagine it).
> >
> > You mentioned you were taking 13 pellets out of a 30 mg. capsule -- did your pdoc suggest this?
>
> **Hell, no. She's just as amazed as I am.
>
> >>I asked the pharmacist if I could open the capsule and dump some out, and he said no, it would cause stomach upset without the enteric coating.
>
> **I'm afraid your pharmacist if wrong. It's not the capsule that's enterically coated, it's each pellet, pretty amazing when you consider their size. I was vomiting for the first week on 30mg, which doesn't say much for their enteric coating.
>
> >>Do you think I should just go ahead and try it? Most docs I know wouldn't be so open-minded.
>
> **This is something you'll have to run through your own knowing and then decide for yourself but don't expect the blessing or guidance of your doc. He/she ought to be interested, but at this point it's a rare protocol and they have nothing to go on. The only encouraging thing you might hear is that at least you're not increasing the dose.
>
> Unfortunately, the bulk of their education, research, grant and hospital money is heavily funded by pharmaceutical companies. Doctors have very little else to go on besides info from their drug reps or clinical stuties performed by drug funded research. They also worry about malpractice suits, etc.
>
> My doctor said that Lilly is heavily promoting Cymbalta right now. She said that the drug rep never once mentioned potential bipolar switching being 'any worse than with the normal SSRI meds' and 20 is a 'substandard dose'. What we're seeing here is the evoluation of how a potentially good drug goes from promosing to dumped because not everyone is the same.
>
> Even my doctor is tentatively happy that I'm responding so well, she's reluctant to suggest this 'not-standard' protocol with any of her other patients, even though EVERY ONE of them is having a terrible time with Cymbalta. She has no 'reputable source' other than my experience and if someone gets worse then it's her fault. A shame all ways around.
>
> As far as I know I'm the only one tracking this, although others are giving me very positive reports. I have some scientific background so I'm not running blind, but this came about through necessity and not any random science project.
>
> What I'm saying is that you'll have to think for yourself on this one and expect you'll be the one forging the way for your doc. So, Cindy, if it were me, I would stop taking that 20mg pill today, instead empty out the capsule and start with 3 pellets for about a week and then take another pellet each 3 days, seeing how you're feeling each time.
>
> > You are giving me great hope here. I am very med sensitive and have had my heart broken many times on meds that seem to help but I can't tolerate the side effects.
> >
> ** I wish you the hope-filled experience I continue to enjoy. But if it isn't the answer, don't give up hope. There's so much going on, so many variables. Hopefully you're in the same group I am in this regard. Hopefully our docs can get with the proram alot better, but their problems are not ours and in the meantime, at the very least we have to do something if we're getting worse. - Barbara
Posted by barbaracat on March 27, 2005, at 20:58:38
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep » barbaracat, posted by Cindy Lou on March 27, 2005, at 18:05:47
Cindy,
Try this link instead:
http://www.dr-bob.org/babble/20050322/msgs/475145.htmlThe other one had an extra character at the end so it bombed out.
Sure hope this works for you. It's not a perfect cure, nothing is. I still have down days but normal ones for a good reason. Considering I was hopitalized I was so depressed just 2 months ago, this is a miracle. There have been a few other variables like getting my thyroid and other hormone meds adjusted, but that's been done before without such a major mood improvement. The only thing that's really different from what I've done before is Cymbalta.
BTW, what kind of mood stabilizer are you taking?
Posted by Cindy Lou on March 27, 2005, at 21:50:24
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep » Cindy Lou, posted by barbaracat on March 27, 2005, at 20:58:38
Hi Barbara,
Thanks for the post. I'm glad you asked about my mood stabilizer (although you might not be so glad since it is a loaded question for me!) I hope it's okay if I ask you some questions about this (and more) ...I take Lithium, but I'm having a hard time figuring out what dose to take. I was taking 450 mg. for several months, but having bad gastrointestinal issues (went through a CAT scan and the whole works since my doctor thought it was a gallbladder issue.) I am thinking the stomach issues were from the Lithium, since they started around the time I started taking it. Also, I tried taking up to 1200 mg. of the Lithium for awhile (before the stomach issues), but was having toxic symptoms even though my blood levels were normal. For us med-sensitive people, could it be that our blood levels do not reflect what is really going on?
Here's another issue -- since you have a science background, maybe you can help me figure this one out: When I had a CBC recently, I was shown to have "atypical lymphocytes" and "slightly elevated amalyse." Would that have anything to do with the Lithium? My doctor thought I might have Mono.
I also seemed to feel a bit more irritable/agitated on the Lithium (and felt the same way on Lamictal when I tried it in the past.) They almost make me feel more volatile rather than stable.
Still, I don't want to give up on the Lithium since my pdoc thinks it will help keep the other meds from pooping out on me (which happens all the time.)
All this to ask your opinion on if I should try lowering the dose of Lithium as well. I do have the 300 mg. tablets now -- can those be dumped into applesauce too?
In addition to the Lithium and Cymbalta, I also take:
- 0.5 mg. Klonapin at night to sleep (nothing else will stop my brain from spinning at night),
- Dexedrine (5 or 10 mg. about 2-3x a day) to help with fatigue and ADD
- 10 mg. Prozac. My doctor said to keep taking the Prozac along with the Cymbalta for now. I have been taking 5 mg. lately since I've been feeling so sick.One last comment and I promise to let you go. I noticed in the thread you directed me to that you and a few others had INCREASED anxiety/agitation on the "normal" dose of Cymbalta. For me, I had NO anxiety, which was a miracle because I was in all sorts of situations which usually induce anxiety attacks. I was just kind of walking around like a zombie, not even occupying my own body. I wasn't at all irritable or agitated at my two young girls. I was so PATIENT. I couldn't believe it was me! However, as the days went on I was so exhausted, spacey, dizzy, disoriented and nauseous, it seemed I was just too dang sick and tired to be anxious. I wonder why the Cymbalta would have evoked such opposite adverse reactions in the two of us?
Okay, that's enough for now! Thanks so much for listening. You have been a real lifeline for me tonight. An Easter gift for me :-)
Gratefully,
Cindy> Cindy,
> Try this link instead:
> http://www.dr-bob.org/babble/20050322/msgs/475145.html
>
> The other one had an extra character at the end so it bombed out.
>
> Sure hope this works for you. It's not a perfect cure, nothing is. I still have down days but normal ones for a good reason. Considering I was hopitalized I was so depressed just 2 months ago, this is a miracle. There have been a few other variables like getting my thyroid and other hormone meds adjusted, but that's been done before without such a major mood improvement. The only thing that's really different from what I've done before is Cymbalta.
>
> BTW, what kind of mood stabilizer are you taking?
Posted by Phillipa on March 27, 2005, at 22:30:15
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep » barbaracat, posted by Cindy Lou on March 27, 2005, at 21:50:24
I felt nothing too on cymbalta and that was up to 60mg. In the past I couldn't tolerate theraputic doses of AD's. I still can't figure out why this happened. I stopped it because I felt apathetic. Fondly, Phillipa
Posted by theo on March 27, 2005, at 22:32:05
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep » barbaracat, posted by Cindy Lou on March 27, 2005, at 14:51:52
> Hello,
> I haven't posted here for awhile ... I could really use some advice.
>
> I just started Cymbalta 4 days ago. They told me the lowest dose is 20 mg., however the side effects have been so bad for me I have to stop -- which is frustrating because I KNOW it was working for me emotionally (no anxiety attacks at all). I have also been diagnosed with BPII, depression and anxiety.
>
> You mentioned you were taking 13 pellets out of a 30 mg. capsule -- did your pdoc suggest this? I asked the pharmacist if I could open the capsule and dump some out, and he said no, it would cause stomach upset without the enteric coating. (I was nauseous WITH the coating anyway.) Do you think I should just go ahead and try it? Most docs I know wouldn't be so open-minded.
>
> You are giving me great hope here. I am very med sensitive and have had my heart broken many times on meds that seem to help but I can't tolerate the side effects.
>
> I look forward to hearing back from you, and anyone else with this experience.
>
> (I wasn't able to read through the whole thread -- sorry if I am asking for repeat info.)
>
> Thank you!!!!
>
> cindy
>
>
>
> > After 6 weeks, I give it a 9. I'm only on 13 pellets out of a 30mg capsule. Stuff is potent. I'm also BP and can't take the usual SSRIs so this is a miracle for me. At this small dose along with lithium 600mg and benzos as needed, I'm doing better than I have in years. God willing it keeps up. - Barbara
> >
> > p.s. How do you guys manage with 60mg? On 30mg I was bug-eyed and crawling on the ceiling.
>
>What side effects were so bad? Won't they pass?
Posted by Cindy Lou on March 28, 2005, at 7:44:51
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep, posted by theo on March 27, 2005, at 22:32:05
> What side effects were so bad? Won't they pass?
Nausea, exhaustion, disorientation (putting applesauce in my daughter's milk cup, ice cream in the refrigerator, etc.), flu-like symptoms, foggy-head. Got worse each day I took it (I only lasted four days). By the last day I was so sick I could barely get throught the day. Caffeine and dexedrine couldn't lift me out of the fog or fatigue.
These symptoms are similar to how I felt on Effexor, and those never passed. I am not the average patient on these meds, and after all these years I know when something will pass and when something won't. Usually when I have bad side effects it helps to start out VERY low and then work up slowly. I am hoping this pellet strategy will work for me.
Thanks for your concern.
cindy
Posted by Patient on March 28, 2005, at 8:36:03
In reply to CYMBALTA ratings 1-10, and effects on anx and dep, posted by qbsbrown on February 24, 2005, at 16:52:07
> I would like people who took it for at least 6 weeks to give me a rating. And also how it treated anx and depression, and the most common side effects.
>
> Thank you people,
>
> BrianIt appears those that do well on it also take other meds, i.e. anti-anxiety meds, mood stabilizers (anti-seizure), high blood pressure meds, and/or other antidepressants. I would be curious to the answer to your question for those that are just taking Cymbalta, or if they had to add another drug to counteract side effects.
Posted by Lynne on March 28, 2005, at 11:23:45
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep » qbsbrown, posted by Patient on March 28, 2005, at 8:36:03
I have taken Cymbalta for over six weeks up to 90mg. I loved it for about the first month. It pooped out on me and no matter what doseage I took I had horrible insomnia. I am now tapering off it.
Lynne
Posted by barbaracat on March 28, 2005, at 22:02:29
In reply to Re: CYMBALTA ratings 1-10, and effects on anx and dep » barbaracat, posted by Cindy Lou on March 27, 2005, at 21:50:24
Dear Cindy,
I'm not a doctor, but hopefully I can help out by thinking some of this through with you.> I take Lithium, but I'm having a hard time figuring out what dose to take. I was taking 450 mg. for several months, but having bad gastrointestinal issues (went through a CAT scan and the whole works since my doctor thought it was a gallbladder issue.) I am thinking the stomach issues were from the Lithium, since they started around the time I started taking it.
**Lithium can cause stomach upsets but unless you're exceptionally sensitive to it, 450mg is not a significant dose.
>>Also, I tried taking up to 1200 mg. of the Lithium for awhile (before the stomach issues), but was having toxic symptoms even though my blood levels were normal. For us med-sensitive people, could it be that our blood levels do not reflect what is really going on?
**The therapeutic range is based on the average of a sample population. But therapeutic for anti-manic has no relation to toxicity for you in particular if something else is going on. For example, was recently talking with cache-monkey on this board who had started lithium and was doing well on 900mg but wasn't at the therapeutic level. His doctor pushed him up to 1200mg and he started developing urinary problems not uncommmon with lithium toxicity.
Whether or not he had a urinary tract weakness before this isn't clear, but this higher dose of lithium, even though it wasn't even in therapeutic, much less toxic range, caused a potentially dangerous condition to surface.
For me, 600mg is plenty, although I'm well below the therapeutic range. Any more than that doesn't improve anything and leaves me with tremors and nausea. We're all unique in our chemistry and those numbers are simply averages. It seems to me that the patient's response and not the numbers should dictate the dosage. I suspect that in your case, more is going on health-wise than sensitivity to lithium, although lithium can cause strange interractions that affect some people and not others.
>
> Here's another issue -- since you have a science background, maybe you can help me figure this one out: When I had a CBC recently, I was shown to have "atypical lymphocytes" and "slightly elevated amalyse." Would that have anything to do with the Lithium? My doctor thought I might have Mono.**Increased or atypical size lymphocytes show a viral infection and are a typical marker of mono, which is caused by the Epstein Barr virus. Amylase is an enzyme that breaks down bile from the liver to the gallbladder and so gall stones may be a cause, but pancreatitis is another thing to look out for since this enzyme usually shows up in pancreatic problems. If your lipase enzymes are also elevated, this would be even more an indication of pancreatic involvement. Since pancreatitis is not a viral but an inflammatory condition, you'd see other markers like high monocytes and white blood count instead of the lymphocyte count.
So this suggests a viral infection that involves liver function (amylase is a liver enzyme). This certainly sounds like mono since mono involves liver function and the two together are suspicious. But other things involve liver and viral, such as Hepatitis.
Another thing to have checked is for tick borne Lyme Disease, which can show these two elevated markers and can cause alot of neurological symptoms. Hopefully, its just mono cause that's not a a biggie to recover from, but you've GOT to really chill out and recover because it can get much worse and compromise liver function for a long time. I had it when I was 18, didn't take care of myself and ended up quite sick for months.
>
> I also seemed to feel a bit more irritable/agitated on the Lithium (and felt the same way on Lamictal when I tried it in the past.) They almost make me feel more volatile rather than stable.**I felt activated on Lamictal everytime I increased it but can't say I've felt edgy on Lithium. I'm trying to remember how it was when I had tremors from it - maybe 'off' because it was just too much, but not volatile.
>
> Still, I don't want to give up on the Lithium since my pdoc thinks it will help keep the other meds from pooping out on me (which happens all the time.)**Whatever is going on that's showing up in your blood work has to be dealt with before anyone can expect lithium or any other mood med to make a lasting difference. If you have mono even at a low level, you're going to feel abolutely rotten. Tired, overwhelmed, irritable, depressed. One way or another, your liver seems to be involved. The liver metabolizes many of our meds so if there's something going, detoxification will be affected.
Lithium is excreted through the kidneys, not the liver, so slower liver detox wouldn't be involved with higher circulating levels, but meds that depend upon the kidneys for excretion may be affected. Lithium can throw off electrolyte levels and this can affect enzymes, one of which is - ta da - amylase! So, it's a real sleuth job to untangle all this.
However, the liver is probably the biggest player and if anything's going on with it, the whole body suffers. All kinds of hormonal systems depend on cholesterol metabolism via the liver and hormones are the chemical messengers throughout the body and brain. The liver is also the seat of anger and depression in Chinese medicine. So, my girl, your physical health has to come first right now.
I'd love to talk more with you about this, suggestions how to deal with it, but since it's off topic on this board, how would you feel about using Babble mail? You can just click on my 'Posted by' name and we can chat about this offline and it'll still be anonymous. - Barbara
Posted by divergent_reality on March 31, 2005, at 11:46:13
In reply to CYMBALTA ratings 1-10, and effects on anx and dep, posted by qbsbrown on February 24, 2005, at 16:52:07
Anixety - 8 - Didn't care about much one way or the other.
Depression - 1
Pain management - 9
Hot Flashes - 7
Weight gain - WAY TOO MUCH FOR ME!
Side Effects - @20 mg. Initally, severe headache 24/7 that lasted about 1 week. Diarrhea for about 3 weeks and after each dose increase. Drowsiness that eventually went away with time.
Started Cymbalta first week in October 2004. Maximum dose 40 mg. Stopped at February 2005 due to depression, steady weight gain (15 lbs.) and excessive gas 24/7.
Side-effects after stopping were the worst I had ever experienced to this date. Just now feeling better.
This is the end of the thread.
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