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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Hopeful at last on February 1, 2005, at 23:43:54
Hi - I have been suffering from treatment resistant depression for three long years - tried everything and dozens of combinations and augmentations. I could open my own pharmacy with all the scripts I have that did not work!
I was wondering if anyone is using Cytomel (T3) to augment Cymbalta. I was on Effexor but switched to 60 mg Cymbalta and 50 mcg Cytomel - so far, I see the first glimmer of light at the end of the tunnel. Supposedly 60 mg of Cymbalta is the theraputic dose. Has anyone taken 80 mg? Would appreciate any feedback on Cymbalta and Cytomel. No one who hasn't been in this dark place can really understand, right?
Posted by saw on February 2, 2005, at 1:52:16
In reply to Has anyone taken more than 60 mg Cymbalta?, posted by Hopeful at last on February 1, 2005, at 23:43:54
Right! It is only the neighbouring dark place abiders that can truly identify. I have been there for 8 years.
I went from Effexor to Lamictal and am now on 60mg Cymbalta. I know that research indicates that there is no established evidence of a higher dosage of Cymbalta being therapuetic. However, it has been tried. A friend suffered high blood pressure after being at 90mg for a week.
My pdoc will more than likely increase my dosage to 90mg at my next visit. I am also treatment resistant.
I don't feel that there is any harm in trying a higher dosage. One will know soon enough if the higher dosage is helping or not.
I am afraid I am not familiar with Cytomel. I periodically take a quarter Remeron just to aid sleep along but not as combination.
Sabrina
Posted by med_empowered on February 2, 2005, at 4:12:58
In reply to Has anyone taken more than 60 mg Cymbalta?, posted by Hopeful at last on February 1, 2005, at 23:43:54
Hey! I only take 60mgs cymbalta. The previous poster is right; even Eli Lilly's own research into the use of higher doses found no additional benefits above 60mgs, and some pretty hardcore side-effects. One of their studies used a 120mgs/day dosage to no avail...in addition, the study had a higher dropout rate. That said, try it by all means, and see what happens, just by all means keep all lab/doctor appointments, monitor your blood-pressure, etc. etc. I personally found that Tofranil (in my case, 200mgs) + Cymbalta (60mgs) worked, although there was a blood-pressure increase (I also take adderall, and tricyclics are notorious for heart-weirdness). Anyway, Cymbalta apparently has a tendency to greatly increase the blood-levels of tricyclics and other antidepressants that may be co-prescribed, so the total effect is greater than the sum of its parts, since a standard outpatient dosage level can reach blood concentrations approaching those usually found in psychiatric inaptients. There are side-effects, yes, but the combo worked for me...best of all, when I discontinued the Tofranil, the cymbalta kept working at maintaining my response AND seemed to keep withdrawal symptoms at bay, which was nice. Good luck!
Posted by Bill LL on February 2, 2005, at 9:03:34
In reply to Has anyone taken more than 60 mg Cymbalta?, posted by Hopeful at last on February 1, 2005, at 23:43:54
Cymbalta is a new drug, so no one, including the manufacturer, knows what the maximum effective dose is for long term usage. They know the maximum for short term use because the clinical trials are relatively short in duration. But of course with many AD's, when you are on them for a a long time, many people need to increase the dosage a few times.
Posted by Racer on February 2, 2005, at 10:55:46
In reply to Re: Has anyone taken more than 60 mg Cymbalta?, posted by Bill LL on February 2, 2005, at 9:03:34
I went up to 90mgs for a while, but then reduced back to 60mgs. The 90 was just too draining on me, lethargic, amotivated, etc. Reducing it helped a bit, but augmenting it with Wellbutrin is what kicked me into a good response.
Your mileage will vary, but I hope that helped.
Posted by Minnie-Haha on February 2, 2005, at 11:44:37
In reply to Has anyone taken more than 60 mg Cymbalta?, posted by Hopeful at last on February 1, 2005, at 23:43:54
I have a RX for a low dose of bupropion / Wellbutrin (that I have not filled yet) to augment my 60mg Cymbalta. I, too, have considered Cytomel and will ask my pdoc about it at the next visit. If you go that direction, keep us posted.
Posted by Phillipa on February 2, 2005, at 18:03:21
In reply to Re: Has anyone taken more than 60 mg Cymbalta?, posted by Minnie-Haha on February 2, 2005, at 11:44:37
So that's why my blood pressure was up. It was when I was on the 60mg of Cymbalta! Fondly, Phillipa
Posted by Minnie-Haha on February 2, 2005, at 19:40:20
In reply to Re: Has anyone taken more than 60 mg Cymbalta?, posted by Phillipa on February 2, 2005, at 18:03:21
> So that's why my blood pressure was up. It was when I was on the 60mg of Cymbalta!
Does that mean you're now on a lower dose of Cymbalta? (Sorry, I have a hard time keeping track of who's on what.) If so, is it working for you AND keeping your BP OK? I might talk to my pdoc about going down to 40mg or something. (I started on 30 and I don't know if that will be enough for me.)
Posted by Phillipa on February 2, 2005, at 20:02:36
In reply to Re: Has anyone taken more than 60 mg Cymbalta? » Phillipa, posted by Minnie-Haha on February 2, 2005, at 19:40:20
No, I went off it. It didn't help at all sorry to say. I'm newly on 50mg of zoloft, l5mg ofremeron at night, plus low dose xanax and tapering off chloral hydrate and klonopin. I forgot she added l0mg of ambien today. My prior pdoc addicted me to benzos and made the newspaper yesterday. Federal agents raided his office and seized pt charts and charged him with health care fraud, and illegal distribution of controlled substances. Needless to say, I'm shaking like crazy and feel very betrayed. I've had to correct many errors typing this post. Fondly, Phillipa
Posted by Hopeful at last on February 3, 2005, at 21:54:55
In reply to Re: Has anyone taken more than 60 mg Cymbalta? » Phillipa, posted by Minnie-Haha on February 2, 2005, at 19:40:20
Thanks everyone for your helpful thoughts! I was previously on a very high dose of EffexorXR (300 mg) and my blood pressure was extremely high. The minute I started titrating down and adding in the Cymbalta, my blood pressure (which had always been normal) immediately went back to that.
I am also augmenting the Cytomel with 150 mg Desipramine (75 in am and 75 at nite) I guess my feeling about increasing mg on Cymbalta (after reading all your posts) is that if I decide to go up, I will know very quickly (as I am very aware of how the meds affect me) if it is helpful or not. There was a time many years ago, when I had a bout of depression and a JUST a simple 30 mg of Prozac or Celexa was all that I needed to get over the hump. This one has been a nightmare - my daughter (who is 14) says she does not even remember how I used to be before I got so sick.
I think that the hardest thing for people to understand is that this time I lost so much of WHO I USED TO BE, HOW I HANDLED LIFE and I can't seem to get it back...
Thanks again for all your comments -Good luck to all of you....!!
Posted by Minnie-Haha on February 4, 2005, at 10:49:57
In reply to Re: Has anyone taken more than 60 mg Cymbalta?, posted by Hopeful at last on February 3, 2005, at 21:54:55
> I think that the hardest thing for people to understand is that this time I lost so much of WHO I USED TO BE, HOW I HANDLED LIFE and I can't seem to get it back...
I can relate to that. I missed the old me most of all. I'm on the Cymbalta now and mostly feel I'm back. My family and friends have noticed it, too. I hope if I have to cut back (because of the blood pressure) that I don't lose that effect.
Posted by Donna Louise on February 5, 2005, at 8:06:10
In reply to I took 90mg for a while..., posted by Racer on February 2, 2005, at 10:55:46
> I went up to 90mgs for a while, but then reduced back to 60mgs. The 90 was just too draining on me, lethargic, amotivated, etc. Reducing it helped a bit, but augmenting it with Wellbutrin is what kicked me into a good response.
>
> Your mileage will vary, but I hope that helped.HI Racer, it seems we are on the same meds. Provigil, cymbalta and wellbutrin. (I also take Buspar and some klonopin. I had tried wellbutrin in the past and couldn't take it in the immediate release form. Now I am the SR 100mg BID and am tolerating it really well. I agree, I think it is the one that is going to bring this all together. I was wondering how many mg you were taking and also was wondering if the XL version would be even better?
Donna
Posted by Racer on February 5, 2005, at 9:58:16
In reply to Re: I took 90mg for a while..., posted by Donna Louise on February 5, 2005, at 8:06:10
> > I went up to 90mgs for a while, but then reduced back to 60mgs. The 90 was just too draining on me, lethargic, amotivated, etc. Reducing it helped a bit, but augmenting it with Wellbutrin is what kicked me into a good response.
> >
> > Your mileage will vary, but I hope that helped.
>
> HI Racer, it seems we are on the same meds. Provigil, cymbalta and wellbutrin. (I also take Buspar and some klonopin. I had tried wellbutrin in the past and couldn't take it in the immediate release form. Now I am the SR 100mg BID and am tolerating it really well. I agree, I think it is the one that is going to bring this all together. I was wondering how many mg you were taking and also was wondering if the XL version would be even better?
>
> DonnaThe XL is once a day dosing, which is great for me, since I can remember to take it once a day. (I can take things at breakfast, because it's such a structured part of my day. The rest of the day kinda comes as it will, so remembering meds later in the day is not as easy.) I'm taking 150mg, but have been thinking it's time to think about going back up to 300mg. There's a lot going on for me, and I'm getting a bit depressed, and more than a little anxious, but again -- that's situational in my case, not med failure.
I've been trying to keep my meds to the minimum necessary to keep me functioning, which is maybe not always the best idea, but I've thought more than a few times that the Wellbutrin alone might be enough to keep me functional. I'm not sure that's true, though, and this ain't the time to try it.
Hope that helps.
Posted by Donna Louise on February 5, 2005, at 19:58:44
In reply to Re: I took 90mg for a while... » Donna Louise, posted by Racer on February 5, 2005, at 9:58:16
I tried taking Wellbutrin by itself once...it was not a good experience to put it mildy. I got so anxious I was verging on paranoia and I do not have psychosis. I have to have some serotonin boost unfortunatley or the anxiety is overwhelming.
Donna
This is the end of the thread.
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