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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by vic80 on June 2, 2010, at 14:25:14
MIL: Started 18 days ago: at 25mg first 4 days, upped to 25mgx2 daily, till 3 days ago - tachycardia and dyspnea - dosage reduced by pdoc to 25mg once daily.
Lexapro - 5 month use - 10mg initially till 3rd month - upped to 15mg - upped to 20mg end of third month - strange side effects - downed to 10 mg in 4th month mid without taper - started effexor - 1st day bad reaction: stopped. lexapro continued at 10mg till mid 5th month - tapered down to zero in 6 days - started Milnacipran.
Lorazepam: 0.5 mg every night, tapered down from 0.5-0.5 over 2 weeks (in all been on it for a month)
in days to follow after MIL started - i experienced heightened anxiety - mini-major panic attacks - tachycardia - dyspnea. Propranolol added to curb tachycardia caused more depression hence stopped.
Feelings of impending, hyper-emotionality esp. sad emotions - crying spells - irritability - lightheadedness - 8-10 hours after morning dosage mood elevation - almost a drugged/drunk feeling. Followed by mood collapse and dysphoria.
The worst bit is that the anxiety I have faced on MIL is more of fear related - always having this ominous fear hanging over my head- unreal fear to be precise. The worst bit is the emergence of suicidal ideation - around the 10th day of the med. Obesessive worries - intrusive thoughts - all these have escalated. A deep feeling of inner darkness and futility - melancholia - stuff I have not experienced earler in the course of depression - which was mainly anhedonia, apathy.
These new symptoms are quite worrisome - because the negative thoughts are very intrusive ruminative and obsessive in nature.
The little highs I felt at the beginning of the treatment were quite rewarding - but I read that lexapro withdrawal too produces hypomanic states - which could be the cause of the short euphoric spells I have encountered in the beginning of MIL as it coincided with lex quick taper.
At the start of MIL also came about some troubling change in my personal life - which perhaps made it difficult figuring out the exact effect of mil. Though I have been accurately been able to differentiate the effect of the med on its own.
I am really not sure what to make out of my progress - 18 days is quite short a time to sum up the efficacy of the drug. But never the less the impending doom/suicidal thots/intrusive-obsessive thoughts are quite worrisome.I wonder if the emergence of melancholia is a side effect of milnacipran - for the first time I am actually thinking it'd be better to be apathetic than to be hyper emotive.
My Pdoc is on vacation for the next 15 days. But nevertheless is always available on phone in emergencies - which I hope do not arise.
I think the best I have felt in months is when I went on MIL and quick tapered lexapro. I wonder what was the magic combo back then....
I am literally in the stage of considering going off meds - I seem to be super-hyper sensitive to them somehow.
I wonder how would a drug with half life of 8 hours work with a single daily dose of 25mg.
Any comments?
Posted by bleauberry on June 2, 2010, at 17:16:16
In reply to Milnacipran/Savella progress, posted by vic80 on June 2, 2010, at 14:25:14
I'm really really sorry you are having such a bad time. I've been in that exact place, and am easily put there again at anytime with any wrong move, so I can certainly relate. You describe it well.
> MIL: Started 18 days ago: at 25mg first 4 days, upped to 25mgx2 daily, till 3 days ago - tachycardia and dyspnea - dosage reduced by pdoc to 25mg once daily.
A decent move, but would have been wiser to split it into 2 or 3 doses instead of one. The halflife is very short, just a few hours.
> I wonder if the emergence of melancholia is a side effect of milnacipran - for the first time I am actually thinking it'd be better to be apathetic than to be hyper emotive.
Melancholia can be an undesired effect of ANY medication that impacts the nervous system. All psych meds can, and do, do that. No matter what the med is, I wouldn't necessarily call it a side effect, but more accurately a direct effect. It is too early since the withdrawal of the other meds to know where to point the finger, but melancholia can be an outcome of starting a med, stopping a med, or being on a wrong med.
>
> I think the best I have felt in months is when I went on MIL and quick tapered lexapro. I wonder what was the magic combo back then....Well, there it is. Low dose lex plus low dose miln. In other parts of the world where there are years of clinical experience with milnacipran in psychiatry, it is combined with SSRIs in the same fashion as combining TCAs with SSRIs. SSRI for the serotonin, Miln for the norepinephrine.
No matter what you do, that once a day dosing thing has to change. The med is too short acting to do any good that way. If a dose is taken at breakfast, it is mostly gone by late afternoon. Cut it in half. Take 12.5 twice, about 6 to 8 hours apart. I know I said it before, the best it treated me was with 6.25mg taken three times per day.
I think there is still some leftover lex withdrarwal readjustment stuff going on too. Lots of chaos going on from that. That stuff can last weeks, even in the backdrop of another medication onboard.
>
> I am literally in the stage of considering going off meds - I seem to be super-hyper sensitive to them somehow.Yeah I sure know that one real well. Others here have reported on it too. Something odd happens when an SSRI is withdrawn. It is quite profound whatever it is. Before going off meds, I think it makes a ton more sense to at least briefly try the suggestions I am about to offer in the last line of this post. It is just pure logic and you are already halfway there anyway.
>
> I wonder how would a drug with half life of 8 hours work with a single daily dose of 25mg.It doesn't. In clinical studies, 50mg twice a day was as good or better than any other antidepressant it was compared to. But 100mg once a day was no better than the placebo group.
>
> Any comments?Spit the dose for multiple dosing. Add back in 2.5mg lex. That's my vote.
Posted by Phillipa on June 2, 2010, at 17:50:45
In reply to Re: Milnacipran/Savella progress, posted by bleauberry on June 2, 2010, at 17:16:16
My vote is call your pdoc as too many side effects and your downward spiral isn't good. Now that is my opinion only. Phillipa
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