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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by sedona on October 22, 2004, at 15:59:46
Hi- I have been taking 60 mg of Cymbalta for two weeks now. During the past five days I have experienced increased anxiety and terrible insomnia. At 30 mg I was sleeping 12-14 hours a day. Has anyone else had problems with anxiety and insomnia on this drug and did it go away?
Thanks
Posted by utopizen on October 22, 2004, at 17:36:14
In reply to Cymbalta 60 mg-side-effects, posted by sedona on October 22, 2004, at 15:59:46
> Hi- I have been taking 60 mg of Cymbalta for two weeks now. During the past five days I have experienced increased anxiety and terrible insomnia. At 30 mg I was sleeping 12-14 hours a day. Has anyone else had problems with anxiety and insomnia on this drug and did it go away?
> Thanksanxiety and insomnia are common startup issues with most psychotropic meds. They're rarely worth giving up a med over. I've tried lots and lots and lots of meds before, and the only meds that ever made me more anxious were Buspar and Abilify. Both went away after a few weeks.
Insomnia, that's nothing to lose sleep over as a side-effect. It's almost never permament, so taking some Ambien for a month is likely more than sufficient. By the time you're adjusted, the insomnia will go away and your depression should be reduced to the point where you can start sleeping with yourself at night.
Just wait it out, maybe ask if you can have some meds to augment with the Cymbalta for while you adjust for the next few weeks. Just don't name drug names. You might get Trazodone prescribed, or something, but just go with it.
If the anxiety's really bad, and your doc doesn't say, "why don't we try some Klonopin?" or something like that, it might be worth "asking" his "advice" on whether using a benzodiazepine would be useful for you while you attempt to adjust to the med's side effects.
It helps you sleep and calm down. (It doesn't sedate you, unless you take too much-- if you feel you need to be sedated, I suggest exploring CBT if you feel you're at that end of the insomnia spectrum).
Posted by sedona on October 22, 2004, at 18:11:13
In reply to Re: Cymbalta 60 mg-side-effects » sedona, posted by utopizen on October 22, 2004, at 17:36:14
Thanks for the advice. I actually do take Klonopin, usually 1 mg per day, but have temporarily raised it to 2 mg. It hasn't been enough to help the anxiety though. I have been on many other AD's, I was just surprised that these side-effects started so late having been at 60 mg for two weeks and previously on 30 mg for three weeks.
Posted by Cairo on October 23, 2004, at 7:00:29
In reply to Re: Cymbalta 60 mg-side-effects » sedona, posted by utopizen on October 22, 2004, at 17:36:14
Desyrel could potentially increase the levels of Cymbalta, so you need to be careful if you are having SE with Cymbalta. I am extremely sensitive to meds and I believe Desyrel, which I have taken for a long time for sleep, has increased my levels of Cymbalta causing terrible agitation and increased BP even at 20mg. Some have reported no problems, but you never know. Here's something I found on MedScape:
DULOXETINE HCL ORAL
Interaction between SSRI's; Duloxetine/Tricyclic Compounds; Trazodone
Severity
3-Moderate Interaction: Assess the risk to the patient and take action as needed.Action
SSRI's and duloxetine impair oxidative hepatic metabolism. These agents may lead to a more rapid down regulation of postsynaptic beta-adrenergic receptors, thus possibly contributing to a faster onset of the antidepressant effect of other agents.Effect
Concurrent administration of an SSRI or duloxetine with a TCA or trazodone may result in an increase in serum levels, toxicities, and/or clinical effects of the TCA or trazodone.Predisposing Factors
None determined.Management
Patients should be observed for increased adverse effects and clinical effects of TCAs at the initiation of concurrent therapy with SSRI's or duloxetine. Plasma concentrations of the TCA should should be monitored and the dosage adjusted accordingly. If SSRI or duloxetine treatment is discontinued in a patient receiving TCA therapy, the dosage of the TCA may need to be adjusted. The effects of fluoxetine on hepatic metabolism may last for 5 weeks after fluoxetine discontinuation. A TCA started after the discontinuation of fluoxetine should be started a lower initial dosage.Discussion
In a study, pretreatment with duloxetine (60mg twice daily) increased the area-under-curve (AUC) of a single dose of desipramine (50mg) by 3-fold. Case reports have shown that the addition of fluoxetine to TCA therapy can result in an increase of 100-300% in the TCA plasma concentration as well as an increase in adverse effects, including seizures and delirium. Fluvoxamine has been shown in an in vitro study to inhibit the metabolism of imipramine. Three case reports have shown increased serum levels of imipramine (32%, 198%, and 470% increases) and an increase in adverse effects (anticholinergic effects, confusion, and sedation) during concurrent administration with fluvoxamine. Two case reports of adverse effects (tonic-clonic seizure, tremors, dizziness, and confusion) and increased plasma desipramine levels (79% and 54% increases) with concurrent administration of fluvoxamine exist. Increased plasma levels of clomipramine (586%) and amitriptyline (100-150%) without signs of clinical toxicity were seen following the addition of fluvoxamine to TCA therapy. Sertraline has been shown to increase the maximum concentration (Cmax) and AUC of desipramine by 31% and 23%, respectively. There is one case report of serotonin syndrome during concurrent therapy with paroxetine and trazodone. The affinity of the different SSRI's for CYP P-450 may vary.Good luck!
Cairo
Posted by ravenstorm on October 23, 2004, at 23:11:49
In reply to Re: Cymbalta 60 mg-side-effects, posted by Cairo on October 23, 2004, at 7:00:29
Why would cymbalta NOT cause problems with anxiety. Wellbutrin is known to cause anxiety in those predisposed to it and it works on norep. The fact that effexor is also an SNRI but is suppossed to be good for anxiety is probably because at lower doses effexor barely works on norep.
Cymbalta works on serotonin and norep. equally, so I would imagine for some people that is just going to be way to activating. Cymbalta has not been approved for anxiety disorders yet.
Posted by sedona on October 24, 2004, at 0:56:45
In reply to Re: Cymbalta 60 mg-side-effects, posted by ravenstorm on October 23, 2004, at 23:11:49
Yes, I am aware that Cymbalta works on norepenephrine and that it has not been approved for anxiety disorders (that will probably come later). Wellbutrin actually calmed me down, but left me very depressed. My question about the side-effects was more about a curiosity as to why these side-effects have appeared recently since I have been taking this medication for five weeks now.
> Why would cymbalta NOT cause problems with anxiety. Wellbutrin is known to cause anxiety in those predisposed to it and it works on norep. The fact that effexor is also an SNRI but is suppossed to be good for anxiety is probably because at lower doses effexor barely works on norep.
>
> Cymbalta works on serotonin and norep. equally, so I would imagine for some people that is just going to be way to activating. Cymbalta has not been approved for anxiety disorders yet.
Posted by ravenstorm on October 24, 2004, at 11:03:58
In reply to Re: Cymbalta 60 mg-side-effects, posted by sedona on October 24, 2004, at 0:56:45
Unfortunately, I'm in quite a mess at the moment because anxiety on WB didn't show up until six weeks after starting it. It is not getting better even with a reduction in dose.
It was the only thing in this year long med-go-round that did anything for my depression and now I will need to quit taking it.
I don't know how I will survive another winter like this.
I had four decent weeks out of fifty two.
Posted by sedona on October 24, 2004, at 14:03:22
In reply to Re: Cymbalta 60 mg-side-effects, posted by ravenstorm on October 24, 2004, at 11:03:58
Hi - I read a few of your other posts and see that you are having a really terrible time. I'm sorry. If Wellbutrin has been helping so much it would be a shame to have to stop it. Do you like the Remeron? Some of the antipsychotics are good for anxiety and of course there are the benzos. I know it can be difficult to bring up benzos to a doctor and I am not sure how you feel about them or how comfortable you are with your doctor. I was fortunate in that my doctor actually suggested Klonopin to me and it has been a lifesaver. I hope that you talk to your doctor soon about the anxiety and your feelings of hopelessness.
Please take care> Unfortunately, I'm in quite a mess at the moment because anxiety on WB didn't show up until six weeks after starting it. It is not getting better even with a reduction in dose.
>
> It was the only thing in this year long med-go-round that did anything for my depression and now I will need to quit taking it.
>
> I don't know how I will survive another winter like this.
>
> I had four decent weeks out of fifty two.
This is the end of the thread.
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