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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by lia mason on December 28, 2004, at 14:29:48
Hi,
I took 60 Cymbalta for 6 weeks and my doc asked me to raise the dose to 90 before I give up. He says that he'd go as high as 120 before throwing in the towel. I just moved (last week) and switched psychiatrists. The new psychiatrist said she agreed with this plan.Now, the drug company says that 60 is the therapeutic dose for all, but it seems that pdocs aren't adhering to this. Anyone have any ideas here? I've looked on the net for discussions about higher dosing, but couldn't find any.
Any insights appreciated. I'm really shocked at my nonresponse to this drug. I seemed to fit the profile of the kind of patient one would expect to respond: melancholic, ruminative depression with chronic pain.
Thanks.
Lia
Posted by Colleen D. on December 28, 2004, at 14:51:41
In reply to cymbalta dosing, posted by lia mason on December 28, 2004, at 14:29:48
Melancholic, ruminative depression with chronic pain is exactly what I have with OCD thrown in. I too am on 60mg Cymbalta and would love to find out more about increasing the dosage above 60mg. I think it's just so new, it may be hard to find info on it unless someone else here has personal experience with it.
Good luck!
Colleen
Posted by BobS, on December 29, 2004, at 9:25:16
In reply to Re: cymbalta dosing » lia mason, posted by Colleen D. on December 28, 2004, at 14:51:41
Cymbalta Users,
After an up and down start, my duloxetine increase seems to have a positive impact. Cocktail is as follows:Cytomel 20 mcg (am before breakfast) to augment Paxil which didn't work the second time around. I stopped it for three years.
Paxil 17.5 mg (one 12.5 mgs CR and 5 mgs IR) in am before breakfast
Cymbalta 80 mgs at bedtime, seems to help with the sleep problem common to Cymbalta.
Xanax, up to 4 mgs as needed. Currently at 3 and trending down if the cocktail works.
My RX is depression (anxious and agitated, hence the Xanax) and mild OCD.
Hope this helps.
BobS.
Posted by Wildflower on December 29, 2004, at 10:04:33
In reply to cymbalta dosing, posted by lia mason on December 28, 2004, at 14:29:48
> Now, the drug company says that 60 is the therapeutic dose for all, but it seems that pdocs aren't adhering to this. Anyone have any ideas here? I've looked on the net for discussions about higher dosing, but couldn't find any.
This happened to me too. I didn't respond well to on 60 or 90 so it was raised to 120. A colleague in my pdoc's office did trials on this dose and found it to be effective contradicting what the manufactur said. She told me that it's common for drug companies to initially advise lower doses. She also pointed out that there are many cases of ADs being initially dosed low (i.e. prozac)and raised later.
> Any insights appreciated. I'm really shocked at my nonresponse to this drug. I seemed to fit the profile of the kind of patient one would expect to respond: melancholic, ruminative depression with chronic pain.
I have a similar syptoms except instead of chronic pain, I have anxiety. Cymbalta has worked the best for me so far and I think I've tried them all.
Posted by lia mason on December 29, 2004, at 10:37:34
In reply to Re: cymbalta dosing - 120 » lia mason, posted by Wildflower on December 29, 2004, at 10:04:33
Thanks so much for responding!
I have no side effects at 90. Did you experience more side effects at 120?
Also... Is everyone taking Cymbalta in the a.m.? I am always fighting fatigue so if there's any chance of a drug making me tired, I like to take it at night. But my pdoc says that the drug company says you really should take this drug in the a.m.--not sure why.
Thanks!
Lia
Posted by Wildflower on December 29, 2004, at 11:03:09
In reply to more side effects?, posted by lia mason on December 29, 2004, at 10:37:34
> I have no side effects at 90. Did you experience more side effects at 120?
The only thing I notice is some occasional twitching of a muscle...especially while laying down. I've also noticed a decrease in appetite.
> Also... Is everyone taking Cymbalta in the a.m.? I am always fighting fatigue so if there's any chance of a drug making me tired, I like to take it at night.I take mine in the morning. I supplement my cymbalta with wellbutrin and lamictal. The wellbutrin helps with energy.
Posted by partlycloudy on December 29, 2004, at 11:44:29
In reply to Re: more side effects? » lia mason, posted by Wildflower on December 29, 2004, at 11:03:09
And I take my 60mg dose at night... plus about 25mg of trazodone to help me sleep and lessen the anxiety the next day.
Posted by RetiredYoung on December 29, 2004, at 14:13:19
In reply to Re: more side effects?, posted by partlycloudy on December 29, 2004, at 11:44:29
I'm going to be taking my new Cymbalta Rx twice per day.
Posted by Bill LL on December 30, 2004, at 9:40:55
In reply to cymbalta dosing, posted by lia mason on December 28, 2004, at 14:29:48
The clinical trials for antidepressants are generally only 6 weeks in duration. But people usually need dose increases over time.
I would definitely listen to your doctor and raise the dose before quitting.
Posted by caraher on January 1, 2005, at 12:51:58
In reply to more side effects?, posted by lia mason on December 29, 2004, at 10:37:34
I'm also now taking 90 mg/day duloxetine after about 6 weeks at 60 mg with no noticeable effect. The increase to 90 seems to have helped and would feel comfortable going to 120. I've noticed no bothersome side effects.
I should add that my doc is/was running trials for Lilly and is surely aware of the recommendation that 60 mg should do the trick. So that number really doesn't seem to mean much. I also know that they ran doses much higher than 120 mg in some trials so my guess is that if you tolerate it well at "moderate" doses it's probably fairly safe to push to higher doses.
Posted by lia mason on January 1, 2005, at 13:28:23
In reply to Re: more side effects?, posted by caraher on January 1, 2005, at 12:51:58
I'm wondering what docs are saying about how long it takes to see benefits. I read some Lily literature that said 2 weeks. My pdoc said you have to give it 4-6 weeks. Experience here?
I switched to Cymbalta from Effexor (which was great for my depression) because my pain doc was getting good results using 60 Cymbalta for pain. I made the transition well in terms of depression, but have seen no benefits at all for pain. I realize the time lines maybe different for depression and pain, but I'd still love to hear experience.
Also... since this is a highly knowledgeable group! I found out years ago that I am a "rapid metabolizer" of tricyclics. Pdocs told me--from my blood levels-- that I was "dumping" the drug quickly. So I took the highest dose to see results: 300 imipramine, for example. Would this experience mean I need more Cymbalta? My Effexor dose was 150.
Thanks!
Lia
Posted by caraher on January 1, 2005, at 21:27:11
In reply to how long to take effect?, posted by lia mason on January 1, 2005, at 13:28:23
i also went as high as 300 mg/day on imipramine, which seemed to work OK. But the side effects were too much for me. I think I was doing better within a week or two of going up to 90 mg duloxetine
Also, I take 60 mg in the AM and 30 in the PM. I haven't experimented much but thought I might as well spread out the dose
Posted by CrazyCO on January 2, 2005, at 21:03:50
In reply to Re: how long to take effect?, posted by caraher on January 1, 2005, at 21:27:11
Not to be discouraging but it took about 10 weeks for Cymbalta to start working for me but now it is working quite well. I went up from 60 to 90mg after about 4 weeks and then up to 120mgs about 4 weeks after that, so maybe it didn't kick in for me until I found the optimum dose for me. Good Luck
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Posted by LP9977 on January 15, 2005, at 14:11:52
In reply to Re: more side effects? » lia mason, posted by Wildflower on December 29, 2004, at 11:03:09
Thank you, thank you everyone out there. I was well established on Effexor XR 300mg/day, but after so many problems with the sexual side effects I wanted to try Cymbalta. I'm on 60mg and I feel like I'm in a fog. I knew the psyche docs took Effexor XR above the recommended levels, but didn't know about the Cymbalta. Glad to know that there's still hope for me with this med. I will try upping it and see how I do. My depression is fine, but my brain just doesn't work.
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