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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Laney on October 20, 2011, at 11:56:43
success with it? It seems like a good choice because it both hits serotonin and norepeniphrine I think fairly equally.
I guess it's worth a try.
What do you think? Would it be a better try before Cymbalta or Effexor?
Thanks!
Laney
Posted by SLS on October 20, 2011, at 12:14:36
In reply to Dropped desiprimine - trying Savella - anyone with, posted by Laney on October 20, 2011, at 11:56:43
> success with it? It seems like a good choice because it both hits serotonin and norepeniphrine I think fairly equally.
>
> I guess it's worth a try.
>
> What do you think? Would it be a better try before Cymbalta or Effexor?
>
> Thanks!
>
> LaneyI can't answer your question.
I can tell you that Effexor and Cymbalta have helped me in the past. Savella did not. Neither did Meridia, another SNRI.
If you pretend that you know nothing about these drugs, what criteria would you use to choose one over the other?
- Scott
Posted by Phillipa on October 20, 2011, at 12:57:22
In reply to Dropped desiprimine - trying Savella - anyone with, posted by Laney on October 20, 2011, at 11:56:43
Laney is your doc willing to get for you? Cymbalta was good for pain at 60mg took it once for three months. I think the only one that did work or my brain adjusted to was the l0mg of paxil. Now brain stuck on luvox and new pdoc yesterday said stick with what I'm on as felt I just have anxiety and he also said that you can have anxiety and not have it lead to depression. So I liked that. You have anxiety also right? Phillipa
Posted by Laney on October 20, 2011, at 19:51:56
In reply to Re: Dropped desiprimine - trying Savella - anyone with » Laney, posted by SLS on October 20, 2011, at 12:14:36
Scott,
"If you pretend that you know nothing about these drugs, (first half of your sentence)
What exactly do you mean by the above? I guess I'm kinda lost here.
Thanks!
Laney
Posted by Laney on October 20, 2011, at 19:55:41
In reply to Re: Dropped desiprimine - trying Savella - anyone with » Laney, posted by Phillipa on October 20, 2011, at 12:57:22
Phillipa,
So your appointment was successful? It sounds like it. Yes, my doctor is willing to prescribe. I don't usually have anxiety with the depression. But.. drugs like desiprimine can certainly change that. Anxiety is a lot less since I stopped it and started getting some sleep.
Hopefully the Savella will work. One can only try right? I liked Nortriptyline for the NE effects so I think that coupled with serotonin sounds like a good plan. Who knows. This all seems to be like a crapshoot to me.
Take care. Hope things continue to go well for you my friend,
Laney
Posted by jono_in_adelaide on October 20, 2011, at 20:33:08
In reply to Re: Dropped desiprimine - trying Savella - anyone with » Phillipa, posted by Laney on October 20, 2011, at 19:55:41
Give it a try and see how it goees.
A realy good seretonin/noradrenalin combo is sertraline (Zoloft) 50mg per day and nortriptyline 75mg at bedtime
Posted by Laney on October 20, 2011, at 20:42:56
In reply to Re: Dropped desiprimine - trying Savella - anyone with, posted by jono_in_adelaide on October 20, 2011, at 20:33:08
Jono,
I know about that combo. I'm trying something different because Nortriptyline put 22 lbs. on my normal 128lb small frame in a matter of 9 months. Not good. I think I could have lived being 150 lbs. but how was I to know that I wouldn't gain even more?? I couldn't afford to keep gaining.
Thanks - I'll let you know how it goes.
Laney
Posted by SLS on October 20, 2011, at 20:54:17
In reply to Re: Dropped desiprimine - trying Savella - anyone with » SLS, posted by Laney on October 20, 2011, at 19:51:56
> Scott,
>
> "If you pretend that you know nothing about these drugs, (first half of your sentence)
>
> What exactly do you mean by the above? I guess I'm kinda lost here.
>
> Thanks!
>
>
> Laney
Have you already tried Effexor?I think most of us are often tempted to operate under the premise that we can pick and choose drugs based upon the mechanisms of action that they are ascribed. There is still much yet to be discovered and understood before we can match drugs to individual patients. We are getting there, though. I think educated guesses can be made, but trial-and-error is still necessary in most cases. If we pretend that we know nothing about the pharmacology of these drugs, how would we go about evaluating their worth? Well, that's how things have been up until now. The brain is still very much a black box, and we don't really know how these drugs work. Why does someone respond to Prozac but not to Zoloft? Both drugs are SSRIs. We should really need only one SSRI if things were that simple. Venlafaxine and sibutramine are both SNRIs, yet sibutramine is ineffective as an antidepressant.
What is more important in choosing a drug to treat depression: presumed pharmacology and theory or clinical statistics and empirical observation?
Which antidepressant works more often, Effexor or Savella? I don't know for sure, but Effexor is a proven product. For as long as Savella has been around, it has not garnered much attention as a first-line drug for treating depression. Right now, I am not aware of any reason to try Savella before Effexor. I wouldn't exclude Savella from consideration, though.
- Scott
Posted by Laney on October 20, 2011, at 21:13:42
In reply to Re: Dropped desiprimine - trying Savella - anyone with » Laney, posted by SLS on October 20, 2011, at 20:54:17
Scott,
I appreciate what your saying. I think about all of these things as well. I have done some searching here and on other sites as well and I liked what Bleauberry said in a previous post:
"My guess is the most likely reason he said that is because he is protecting himself from any troubles with his Board or with insurance carriers. That's because if something goes wrong in the treatment, he could be scrutinized for prescribing an off label med when he should have prescribed firstline meds instead. Off label doesn't seem to be a problem after it has been done a while and a lot of doctors do it. With savella however it hasn't been on the market very long so I don't think it has built a following or a pattern yet.The fact that it is new could be a factor as well. Maybe the doctor is just more comfortable sticking within his comfort zone?
The manufacturers of savella I think must have been very concerned about the risks of psychiatric prescriptions because they went out of their way to overemphasize in their label that savella is not an antidepressant and could have suicide risk or cause depression. That is actually true of all the psych meds equally, but they purposely put it right on the table so no one could miss it. That, I believe, in an attempt to protect themselves while entering the dangerous waters of the USA prescription market. I think they were perfectly happy going for the fibromialgia market and didn't want the risk of the depression market.
That said, savella has been approved as an antidepressant in other countries for many years. It's one of the few primary antidepressants in Japan. It has a large number of clinical studies on it including some with treatment resistant depression. Speaking only for myself, it put a significant dent in my ECT resistant depression rather quickly at a super low dose.
So I don't know what the fuss is all about. Some people are comfortable managing their own decisions. If that were the case, savella is easily ordered by mail without a prescription from overseas. Not recommending it, just sayin.
What you could do maybe is ask the doctor what he wants you to try. Go along with it and show some enthusiasm and interest in the idea. Then tell him you are even more excited than that with savella. Then strike a deal. Tell him you would like to try savella right now, and that the deal is if it goes badly then the doctor's idea is next up. The doctor/patient relationship really should be one of that kind of trust and give-n-take. If it's not, then it's not a good relationship and either needs to be nurtured or dissolved."
It made sense to me and I figured why not give it a try? I also understand that effexor at the larger doses finally hit NE but at the lower doses doesn't do much except hit SE.
Thanks again! I do appreciate this site!
Laney
Posted by jono_in_adelaide on October 20, 2011, at 22:26:46
In reply to Re: Dropped desiprimine - trying Savella - anyone with » SLS, posted by Laney on October 20, 2011, at 21:13:42
Ouch, the weight gain can be a kiler.
Best of luck, I hope this is the oen that works for you. If not, dont give up, keep on looking.
Posted by SLS on October 21, 2011, at 2:21:23
In reply to Re: Dropped desiprimine - trying Savella - anyone with » SLS, posted by Laney on October 20, 2011, at 21:13:42
> Speaking only for myself, it put a significant dent in my ECT resistant depression rather quickly at a super low dose.
Why did you not continue with it?
- Scott
Posted by Laney on October 21, 2011, at 10:47:03
In reply to Re: Dropped desiprimine - trying Savella - anyone with » Laney, posted by SLS on October 21, 2011, at 2:21:23
Scott,
I'll have to look it up later but I think it affected his bladder in a negative way.
I'll try to find it and post it later.
Laney
Posted by Laney on October 21, 2011, at 10:52:51
In reply to Re: Dropped desiprimine - trying Savella - anyone with, posted by Laney on October 21, 2011, at 10:47:03
Scott,
This is what Bleauberry stated in a previous post concerning his Savella experience
"I liked Savella, but during the first week I did have the roller coaster stuff you described. I couldn't stay with it long enough to see if they would level off. I just loved it so much when it was "on". The side effects for me were too much peripheral norepinephrine stimulation (the bladder)."
Laney
Posted by SLS on October 21, 2011, at 11:15:30
In reply to Re: Dropped desiprimine - trying Savella - anyone with » Laney, posted by Laney on October 21, 2011, at 10:52:51
Hi Laney.
What was the dosage of Savella that you used?
I would like to know who is benefiting long-term from using Savella at low dosages.
When Savella was tested at 100mg and 150mg, more people respond to the higher dosage than to the lower dosage. Here is one study that I came across when I tried this drug:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656309/
- Scott
Posted by SLS on October 21, 2011, at 11:20:47
In reply to Re: Dropped desiprimine - trying Savella - anyone with » Laney, posted by Laney on October 21, 2011, at 10:52:51
> Scott,
>
> This is what Bleauberry stated in a previous post concerning his Savella experience
>
> "I liked Savella, but during the first week I did have the roller coaster stuff you described. I couldn't stay with it long enough to see if they would level off. I just loved it so much when it was "on". The side effects for me were too much peripheral norepinephrine stimulation (the bladder)."
>
> LaneyI am confused. Did you try Savella, or not?
- Scott
Posted by Laney on October 21, 2011, at 17:32:06
In reply to Re: Dropped desiprimine - trying Savella - anyone with » Laney, posted by SLS on October 21, 2011, at 11:20:47
Scott,
I was quoting from Bleauberry on his experience with Savella. I have not tried it yet. Picking it up today.
I tried to show that by using quotation marks. Sorry if it was confusing.
I'm going to have to give it a try as I had to talk my pdoc into it in the first place. He wanted to try Effexor first.
So, I'll have to give it a shot.
Thanks,
Laney
Posted by bleauberry on October 22, 2011, at 3:51:00
In reply to Dropped desiprimine - trying Savella - anyone with, posted by Laney on October 20, 2011, at 11:56:43
As with all drugs, Savella has the potential to help some people a lot, and others not at all. Take me and SLS for example. The drug was able to do for me what no other drug or ECT could do and it did it fast at a sub-normal dose. But for SLS it did nothing all the way up to a high dose.
My guess is it is determined by the integrity, structure, functionality, of the norepinephrine system, and maybe to a lesser extent the serotonin system. Those issues will vary a great deal from one person to another.
This is the end of the thread.
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