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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by West on July 22, 2008, at 22:40:41
I have to make a decision within the next week over choosing one of these two medications. I apologise for covering old ground but descriptions of experiences in people who've taken BOTH would be helpful. I am med sensitive and found bupropion very anxiety provoking. Specifically i'm looking for any measurable changes people had on perceived quality of life, appetite, friendliness, energy, sleep, libido, emotional sensitivity and any others worth mentioning. Thanks!
Posted by dcruik518 on July 23, 2008, at 0:31:41
In reply to Which is superior Duloxetine or Venlafaxine ?, posted by West on July 22, 2008, at 22:40:41
I've taken both cymbalta and pristiq (the brand name for the drug you're talking about). They definitely made me feel very different. Cymbalta to me felt like a super-powerful-SSRI. It was very calming and I could just lay back in my recliner and be perfectly at peace for hours. I didn't get much done on it though. Pristiq for me so far (3 weeks) seems to have a subtle mood lifting effect, but I just don't feel like I'm taking anyting, it feels more like a trick, or a placebo effect. I don't know for sure. On Cymbalta you definitely can feel it. On pristiq you might just sort of notice one day that your mood is a bit better. For be both cause pretty severe sexual side effects.
Posted by dcruik518 on July 23, 2008, at 0:57:03
In reply to Re: Which is superior Duloxetine or Venlafaxine ?, posted by dcruik518 on July 23, 2008, at 0:31:41
Sorry, I thought you were referring to the new and improved Effexor, which is desvenlafaxine.
Posted by Amigan on July 23, 2008, at 7:25:01
In reply to Which is superior Duloxetine or Venlafaxine ?, posted by West on July 22, 2008, at 22:40:41
> Specifically i'm looking for any measurable changes people had on perceived quality of life, appetite, friendliness, energy, sleep, libido, emotional sensitivity and any others worth mentioning. Thanks!
I haven't tried any of these meds, but i read that Venlafaxine is more energizing than Duloxetine. So, it may be a better choise for what you seek except of sleep.
Posted by Phillipa on July 23, 2008, at 12:06:09
In reply to Re: Which is superior Duloxetine or Venlafaxine ?, posted by Amigan on July 23, 2008, at 7:25:01
During peri-menopause tried effexor at that time it was too stimulating. I know quite few people that said it helped anxiety and didn't have more than a few brain zaps coming off it. I did try cymbalta twice after menopause up to 60mg the first time with benzos for three months and noticed nothing until going off it and then once off it had body aches and pains I never had before. Still have them so I do think it's good for pain. Second time tried it was a new doc and I think because I didn't trust him I couldn't tolerate even 30mg so after l0 days went off it. Never had withdrawal symtoms. Phillipa
Posted by West on July 23, 2008, at 13:57:35
In reply to Re: Which is superior Duloxetine or Venlafaxine ?, posted by Amigan on July 23, 2008, at 7:25:01
'I haven't tried any of these meds, but i read that Venlafaxine is more energizing than Duloxetine. So, it may be a better choise for what you seek except of sleep.'
I've also read this. Strange considering that venlfaxine inhibits norepinephrine and serotonin at a ratio of 1:200 in vivo, and duloxetine 1:10. I assume the stimulatory effect is down to its its belonging to the phenylethylamine class like phentermine/bupropion/amphetamine. Just goes to show that stronger affinity for NA doesn't necessarily make for a more energizing profile. On the other hand, askapatient.com has lots of people complaining of sleepiness and apathy.
Posted by Amigan on July 23, 2008, at 14:30:42
In reply to Re: Which is superior Duloxetine or Venlafaxine ?, posted by West on July 23, 2008, at 13:57:35
> 'I haven't tried any of these meds, but i read that Venlafaxine is more energizing than Duloxetine. So, it may be a better choise for what you seek except of sleep.'
>
> I've also read this. Strange considering that venlfaxine inhibits norepinephrine and serotonin at a ratio of 1:200 in vivo, and duloxetine 1:10. I assume the stimulatory effect is down to its its belonging to the phenylethylamine class like phentermine/bupropion/amphetamine. Just goes to show that stronger affinity for NA doesn't necessarily make for a more energizing profile. On the other hand, askapatient.com has lots of people complaining of sleepiness and apathy.Yes, i find it strange too. Perhaps Duloxetine has higher affinity for histamine-1 receptors. This is the usual suspect for meds that suppose to be activating, but they are not.
Posted by Chris O on July 23, 2008, at 14:43:51
In reply to Which is superior Duloxetine or Venlafaxine ?, posted by West on July 22, 2008, at 22:40:41
I've taken both Cymbalta and Effexor, albeit for limited (two-weeks or so) periods. However, that didn't seem to matter as both worked fairly quickly. I have GAD and depression. I found Effexor to be very stimulating, and very powerful. I was on the lowest dose (37.5mg). The effects are felt almost immediately, and they were definitely on the stimulating side. I also had a very bad headache on Effexor, so I stopped taking it. Cymbalta was much milder. It had some stimulating qualities but not nearly as much as Effexor. On a negative note, I had a hard time going to the bathroom on both drugs. On Cymbalta, I didn't go to the bathroom for two days, which I found incredibly disturbing. However, I know a lot of people have success with these drugs, so...maybe they're just not suited to my body chemistry. Good luck!
Posted by linkadge on July 23, 2008, at 15:32:11
In reply to Re: Which is superior Duloxetine or Venlafaxine ?, posted by West on July 23, 2008, at 13:57:35
I've heard that venlafaxine functionally inhibits the norepinephrine transporter with a different mechanism from other drugs and that it may be difficult to directly compare it to other SNRI's for this reason (?)
Linkadge
Posted by West on July 23, 2008, at 17:26:51
In reply to Re: Which is superior Duloxetine or Venlafaxine ? » West, posted by linkadge on July 23, 2008, at 15:32:11
Is it possible that a greater increase in extracellular dopamine happens with Ven not related to any downstream effect increase of DA through NE reuptake?
Posted by West on July 23, 2008, at 17:53:06
In reply to Re: Which is superior Duloxetine or Venlafaxine ?, posted by West on July 23, 2008, at 17:26:51
Or more plausibly, norepinephrine (if we are taking the term stimulating to mean noradrenergic. Any Initial euphoria could be seen as a response to extracellular dopamine increase)
From 'Desvenlafaxine succinate: A new serotonin and norepinephrine reuptake inhibitor.
Inhibition of [3H]5-HT or [3H]NE uptake by DVS for the hSERT or hNET produced IC50 values of 47.3 +/- 19.4 and 531.3 +/- 113.0 nM, respectively. DVS (10 microM), examined at a large number of nontransporter targets, showed no significant activity. DVS (30 mg/kg orally) rapidly penetrated the male rat brain and hypothalamus. DVS (30 mg/kg orally) significantly increased extracellular NE levels compared with baseline in the male rat hypothalamus but had no effect on DA levels using microdialysis.'
Posted by linkadge on July 23, 2008, at 20:55:43
In reply to Re: Which is superior Duloxetine or Venlafaxine ?, posted by West on July 23, 2008, at 17:53:06
I just think that on paper, venlafaxine should be that stimulating. It increased my BP like 20 points on just 37.5-75mg.
Actually paxil also has affinity for the norepinephrine reuptake pump and if I remember is in the same range as venlafaxine on paper. But for me, paxil was sedating and venlafaxine was very stimulating. It might have some effect on monoamine release too.
Linkadge
Posted by West on July 23, 2008, at 23:51:48
In reply to Re: Which is superior Duloxetine or Venlafaxine ?, posted by linkadge on July 23, 2008, at 20:55:43
>>I just think that on paper, venlafaxine should be that stimulating. It increased my BP like 20 points on just 37.5-75mg.
None of these class of drugs affect monoamine oxidase. I am hoping to manipulate the half-life (althuogh not ideal) to keep active in the day and relaxed enough at night to sleep without using something like zopiclone.
I'm on that now, and moclobemide, and haven't slept yet (i'd say it's about 6am). Someone should market moclobemide as a wakefulness promoting agent; it's a sh*t antidepressant.
Posted by dcruik518 on July 24, 2008, at 13:43:36
In reply to Re: Which is superior Duloxetine or Venlafaxine ?, posted by dcruik518 on July 23, 2008, at 0:31:41
I have taken both and for me they have very very different effects. Cymbalta feels a bit like Paxil, but magnified several times, very calming, very relaxing, usually sedating, blissful, calm apathetic, non-motivated feeling. Effexor, in contrast, was very stimulating, made me extremely nervous around people, improved my "mood" in "bright" way but did nothing for confidence, made me gain weight. I liked the Cymbalta much better personally but it caused a weird side effect where I trouble speaking fluently on it. I have no idea why these two SNRIs have such different profiles. I do know, however, that Cymbalta is an EXTREMELY potent serotonin drug.
Posted by Phillipa on July 24, 2008, at 19:53:57
In reply to Re: Which is superior Duloxetine or Venlafaxine ?, posted by dcruik518 on July 24, 2008, at 13:43:36
Guess I'm the wierdest as SSRI's don't sedate me wish they did and Link I also found effexor stimulating so much so even with benzos had to quit. Phillipa
Posted by linkadge on July 24, 2008, at 21:23:47
In reply to ))Linkadge, posted by West on July 23, 2008, at 23:51:48
MAOI's can really mess up sleep. You could try venlafaxine immediate release of the XR keeps you up at night.
Linkadge
Posted by BGB on July 27, 2008, at 18:19:06
In reply to Re: ))Linkadge, posted by linkadge on July 24, 2008, at 21:23:47
Venlafaxine and duloxetine are similar in my opinion, although I found venlafaxine to be more efficacious for my depression. Unfortunately, it is very hard on my stomach, so I switched to duloxetine. I think that duloxetine has fewer side effects all around.
Posted by yxibow on July 29, 2008, at 1:27:06
In reply to Which is superior Duloxetine or Venlafaxine ?, posted by West on July 22, 2008, at 22:40:41
> I have to make a decision within the next week over choosing one of these two medications. I apologise for covering old ground but descriptions of experiences in people who've taken BOTH would be helpful. I am med sensitive and found bupropion very anxiety provoking. Specifically i'm looking for any measurable changes people had on perceived quality of life, appetite, friendliness, energy, sleep, libido, emotional sensitivity and any others worth mentioning. Thanks!
If you've found Wellbutrin anxiety provoking you're likely to find Effexor fiery. But then they both work so differently -- Effexor doesn't focus so much on dopamine. Cymbalta is much more subtle. For some its the opposite, not in my book. Some people do find Cymbalta sleepy, and thus would find Effexor energizing. If your chemistry is anything like mine, you'll sure have a fun sex life with Wellbutrin, other than having it burn your head on fire (almost literally, like eczema).I don't thing either have a significant effect on libido, but that's just my story.
Posted by West on July 29, 2008, at 11:00:30
In reply to Re: Which is superior Duloxetine or Venlafaxine ? » West, posted by yxibow on July 29, 2008, at 1:27:06
>If your chemistry is anything like mine, you'll sure have a fun sex life with Wellbutrin, other than having it burn your head on fire (almost literally, like eczema).
I don't thing either have a significant effect on libido, but that's just my story.
Ha LOL. Well i concede i did feel quite vigorous while taking it, although there was a scatty, manic side too.
I suppose i want subtle over crude. The stimulation however sounds like sweet music right about now, i wonder if ven would worsen the impressively downer-resistant insomnia i'm haveing the pleasure of entertaining on moclobemide.
If i do find, as many seem to, cymbalta too serotonergic, i suppose i could add bupropion independent of my gp's jurisdiction. Maybe this would be a better combination than combining with ven, or ven on its own. Who knows ?
Selfishly, i suppose, i am planning a move soon and don't particularly want to wait several months for an antidepressant effect. Perhaps if effexor didn't agree i could be expected to switch without too much trouble.
Posted by dapper on July 30, 2008, at 2:01:08
In reply to )yxibow, posted by West on July 29, 2008, at 11:00:30
Best of luck to you...It's said time and again, everybodys chemistry is different. Cymbalta was similiar to effexor, but more mild effects on me. Also, it 'pooped out' on me pretty quickly. Effexor has been one of, if not the most, powerful AD drug I have taken. In my situation, I combined the effexor with lamictal and wellbutrin and that was the best 'cocktail' for me. But if your like me, you can kiss your libido good bye for the most part. Oh, and getting off effexor was by far the worst withdrawals I have had. Once your on, getting off is very hard.
Posted by dcruik518 on August 4, 2008, at 7:23:52
In reply to Re: Which is superior Duloxetine or Venlafaxine ? » West, posted by yxibow on July 29, 2008, at 1:27:06
Although they are both SNRIs, Cymbalta and Effexor have very different effects. Cymbalta is not really stimulating at all, just the opposite, good for anxiety. Effexor tends to be very energizing and can provoke anxiety. So would you rather be sort of dull and calm or nervous but energized? Personally, I find Pristiq--desvenlafaxine--to be better than either one. Unlike Effexor, it doesn't make me nervous, but it still has some energizing effect. It's a fairly subtle drug, but it works. Pristiq has only been out for a couple of months, I think. It's very expensive, but I get free samples.
Posted by West on August 9, 2008, at 18:23:14
In reply to Re: Which is superior... tried Pristiq?, posted by dcruik518 on August 4, 2008, at 7:23:52
Hi
I know it's kind of obsolete posting this now but i thought i'd provide a bit of an update. Begun taking 30mg of cymbalta (absurdly named 'xeristar' here in the UK) and have been feeling in a heavy fog and have cold sweaty armpits, bonus is i can't sleep either, although that i am used to.
The serotonin effect is a relief after 6 months off antidepressants and a relapse into dead-land with sleepless nights tossing and turning with phantom bed itches and awful restless thoughts. Unfortunately we don't have the cleaved d-isomer of venlafaxine available for our delectation in this country at present.
My ideas are no more sophisticated than considering wacking bupropion in there or changing to effexor and doing the same. I chose cymbalta (over effexor) to avoid side effects, but if the primary 'mood' of cymbalta is of a semi-comatose sweat pig i really have to question the decision. I have heard of people reporting better memory and feeling more 'with it' on cymbalta, which i confess confuses me as it brings me to doubt whether they were technically alive-with-pulse-humans on effexor prior to C.
I don;t think this can be IT. The end of the line. I don't want to feel like this forever. Perhaps anyone who has championed either in combination with wellbutrin could pipe up with some super-sky-rocketingly positive accounts? Also there's the enzyme issue which apparently raises blood levels of both - or is this no so ?
This is the end of the thread.
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