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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Phillipa on December 22, 2005, at 16:29:24
Saw the new pdoc and he rx'd 30mg cymbalta for a week, then 60mg for a week, then 90mg for a week, then 120mg for a week. I told him the manufacturer claims doses over 60mg don't give any more response. He said his average dose is 120mg . Any thoughts, comments appreciated. Won't start til I get back. Oh we're leaving now till Monday but I will have computer access. So please write. Love Phillipa
Posted by ShellyM on December 22, 2005, at 16:55:36
In reply to New PDoc RX'd High Dose Cymbalta, posted by Phillipa on December 22, 2005, at 16:29:24
Hi Phillipa
I am on Cymbalta too- just started 60mg after being on 30mg. I stayed on 30mg longer than the Dr. recommended, but started getting really tired so thought I should go to recommended dose. I have to say, I sleep more than ever which isn't what I was hoping for. My Dr. assures me on 60mg that will get better.
I heard the same thing you did....anything over 60mg isn't useful, but I have an appointment with my PDoc tomorrow and will ask him.
Good luck on it and safe travels.
Shelly
> Saw the new pdoc and he rx'd 30mg cymbalta for a week, then 60mg for a week, then 90mg for a week, then 120mg for a week. I told him the manufacturer claims doses over 60mg don't give any more response. He said his average dose is 120mg . Any thoughts, comments appreciated. Won't start til I get back. Oh we're leaving now till Monday but I will have computer access. So please write. Love Phillipa
Posted by ed_uk on December 22, 2005, at 17:08:44
In reply to New PDoc RX'd High Dose Cymbalta, posted by Phillipa on December 22, 2005, at 16:29:24
Hi PJ!
>120mg
It seems quite common. Even here, I've seen a few prescriptions for 120mg.
Love
ed
Posted by Jakeman on December 22, 2005, at 20:39:06
In reply to New PDoc RX'd High Dose Cymbalta, posted by Phillipa on December 22, 2005, at 16:29:24
Cymbalta worked wonders for a friend of mine who starting taking it 6 months ago. He had gotten to the point where he was afraid to go out of his house. He says he sleeps less but that hasn't been a major problem. He still desires sex but can't find it. I'll stop there.
good luck ~Jake
Posted by fairywings on December 22, 2005, at 20:47:20
In reply to New PDoc RX'd High Dose Cymbalta, posted by Phillipa on December 22, 2005, at 16:29:24
Hi Phillipa,
Use your own best judgment. Start at 30, and don't go up until you feel ready. Then if and when you go to 60 stay there until you're ready, and so on. 30 might work, 60 might, and you might find you need more, who knows. Everyone is diff., and for a doc to Rx for you what he would for someone else because it works for them is silly. My pdoc is really good about listening to what is working for me, not my kids, not the person who was in the last appt.
fw
Posted by med_empowered on December 22, 2005, at 23:29:37
In reply to Re: New PDoc RX'd High Dose Cymbalta » Phillipa, posted by fairywings on December 22, 2005, at 20:47:20
I dont know. I had a doc who was thought "cymbalta is like zoloft, plus straterra..it'll be great for adhd". So, I took 90mgs/day and...nothing. Absolutely nothing, except heightened anxiety. The Lilly studies, by the way, used exactly your dose--120mgs/day--and found no real benefit above and beyond the 60mgs/day, for either neuropathic pain or depression. I think maybe shrinks don't like to be told what to do--a sort of, "I'm the doc, I'm the expert, I'll prescribe as much or as little as I want to, blah blah blah"
Anyway, here's what I'd do--since 60mgs is the ideal dose, fill the 120mgs RX and just take one of the 60mgs caps per day. Your shrink's crazy prescription just allowed you to basically cut your co-pay in half. Yay!!!
Cymbalta plus Tofranil and Adderall worked pretty well for me. Maybe if instead of taking high-dose cymbalta you could add in something that played on dopamine and/or norepinephrine, that would help?
Good luck!
Posted by yxibow on December 23, 2005, at 0:27:18
In reply to Re: New PDoc RX'd High Dose Cymbalta » Phillipa, posted by ed_uk on December 22, 2005, at 17:08:44
> Hi PJ!
>
> >120mg
>
> It seems quite common. Even here, I've seen a few prescriptions for 120mg.
>
> Love
>
> ed
I moved from 60 to 80 to in the past week or two 90, and as in a previous post, I'm beginning to think that the 90 has improved my mood much brighter (I have an unrelated rare disorder, but there's more of a "I dont care about it as much" feeling, which I think may be a mood change. Who knows -- dont want to rock the boat yet as they say). The next increase with my insurance would have to be 110 or 120 (they count pill sizes.. probably to get extra copays).cheers
Posted by ed_uk on December 23, 2005, at 13:04:32
In reply to Re: New PDoc RX'd High Dose Cymbalta, posted by med_empowered on December 22, 2005, at 23:29:37
Hi Med
In the short term, 120mg isn't generally any more effective than 60mg. In the long term, who knows???? Some people inevitably require much more/less than others. There are both pharmacokinetic and pharmacodynamic reasons for this. Clinical trials provide useful guidance as to what doses are most likely to be suitable...... but determining the best dose for a given individual is a matter of trial and error.
Tidings :-)
Ed
Posted by mogger on December 23, 2005, at 15:36:04
In reply to Re: New PDoc RX'd High Dose Cymbalta, posted by yxibow on December 23, 2005, at 0:27:18
Go for it, just try it out, you have nothing to loose!
mogger
Posted by blueberry on December 23, 2005, at 17:34:48
In reply to New PDoc RX'd High Dose Cymbalta, posted by Phillipa on December 22, 2005, at 16:29:24
My take on cymbalta is a little different than the other posts here. I'm always so afraid of new meds that I start them super low to check it first.
I've tried cymbalta 3 times, but never committed to it...I'm so afraid of the withdrawals if it doesn't work out. Fear gets in my way with these meds. Anyway, I emptied a capsule and put just 8 beads in my mouth and swallowed with water (there are about 300 beads in a capsule). Six hours later I felt great. I moved up to about 20 beads over 3 days, which I think is only about 2mg or 3mg, and it kind of lost its initial goodness, and then for some reason I just decided not to go there...so afraid of withdrawals. Strange, even after just a few days at a miniscule dose, I did indeed have horrid withdrawals for about 2 days.
Anyway, I've given up on everything else. I'm trying other natural stuff now, but if I get in trouble, cymbalta is the one and only med in mind as my life preserver. I know from experience it can lift me up fast.
I couldn't even imagine doing 30mg, or 60mg. Wow.
Posted by Phillipa on December 23, 2005, at 18:45:34
In reply to Re: New PDoc RX'd High Dose Cymbalta » med_empowered, posted by ed_uk on December 23, 2005, at 13:04:32
Ed should I do it now I'm scared! And my anxiety is sky high. At my son's not good for Christmas and I took over 25mg of valium last night to sleep. I take nothing during the day. What please tell me what to do! Why do so many think cymbalta is so strong. Took 60mg last year and nothing happened good or bad. What in the world is wrong with me! And lexapro created horrible anxiety for me . And Med I thought the SNRI was norepenephine isn't that like dopamine? I'm getting more confused all the time. Help ED!!!!Love PJ O
Posted by ed_uk on December 24, 2005, at 18:45:35
In reply to Re: New PDoc RX'd High Dose Cymbalta » ed_uk, posted by Phillipa on December 23, 2005, at 18:45:34
Hi PJ
I think you should do as your new pdoc has suggested. Given your previous lack of response to 60mg, trying a higher dose seems reasonable.
>Why do so many think cymbalta is so strong?
Some people seem to do well on very small doses.
Love
Ed xxx
Posted by Phillipa on December 24, 2005, at 20:34:16
In reply to Re: New PDoc RX'd High Dose Cymbalta » Phillipa, posted by ed_uk on December 24, 2005, at 18:45:35
But Ed does this mean I'm treatment resistant? And in the past I couldn't tolerate even low doses. Love PJ O
Posted by ed_uk on December 24, 2005, at 20:51:13
In reply to Re: New PDoc RX'd High Dose Cymbalta » ed_uk, posted by Phillipa on December 24, 2005, at 20:34:16
>But Ed does this mean I'm treatment resistant?
No PJ, you haven't tried enough treatments to be deemed treatment resistant :)
Ed xxx
Posted by inquisitive1 on December 25, 2005, at 11:29:28
In reply to New PDoc RX'd High Dose Cymbalta, posted by Phillipa on December 22, 2005, at 16:29:24
Clinical Trials of Duloxetine for Major Depression
Four randomized, placebo-controlled, clinical trials of duloxetine for major depression have been published.[44–47] The studies are reviewed separately below, and additional details are provided in Table 1 . Patient baseline characteristics, inclusion and exclusion criteria, and methodology were comparable. Unless stated otherwise, a response was defined as a 50% or greater decrease in the HAMD17 score and remission as a HAMD17 score of ≤7. Patients were excluded if they had a major depressive episode within the preceding four months. Prescription pain and antihypertensive medications were not allowed. Patients had to meet the criteria for depression as defined by DSM-IV and needed to have a baseline HAMD17 score of not less than 18. Patients who had failed to respond to at least two adequate courses of antidepressant therapy (i.e., received each drug for at least four weeks) were excluded. All studies were in accordance with the ethical standards of the institutions where they were conducted.All four of the placebo-controlled trials of duloxetine primarily analyzed data by using a mixed-effects model for repeated-measures approach. This approach has been described elsewhere, as has the authors' rationale for using it.[48,49] However, depression studies and comparisons have traditionally been done with outcomes based on last-observation-carried-forward (LOCF) analysis.[50,51] To adequately assess duloxetine in relation to outcomes as typically reported in studies of MDD, this review will focus primarily on LOCF analysis.
Goldstein et al.[44] conducted a randomized, placebo-controlled, double-blind trial in adults with MDD at eight sites over an eight-week treatment period. Patients were assigned to receive an escalating dosage of duloxetine, fluoxetine 20 mg daily, or placebo. In the duloxetine treatment group, dosages were initiated at 40 mg per day (administered as 20 mg twice daily) and increased to 120 mg per day (60 mg twice per day) by the third week. Dosage adjustments of duloxetine were required, but the investigators were allowed to withhold a dosage escalation if there were concerns about safety or tolerability. During the treatment phase, 34% of patients in both the duloxetine and placebo groups and 36% taking fluoxetine discontinued treatment and withdrew from the study. One third of those who discontinued duloxetine did so because of adverse events, but a significant number of patients taking placebo discontinued it because of lack of efficacy.
Detke et al.[45] conducted a randomized, multicenter, double-blind trial that assigned 245 patients to either duloxetine 60 mg once per day or placebo for nine weeks. Patients 18 years and older who met DSM-IV criteria for MDD were included in the study. Patients who could not tolerate 60 mg once per day were permitted to reduce the duloxetine dosage to 40 mg per day for a maximum of three weeks. Patients in the duloxetine group had a greater reduction in HAMD17 scores than patients in the placebo group and had significantly reduced scores of anxiety and pain on HAMD17 subscales compared with patients receiving placebo.
Another randomized, double-blind, placebo-controlled study evaluated duloxetine for the treatment of major depression in 267 patients at 21 U.S. sites over nine weeks.[46] Patients were initiated at 60 mg per day for duloxetine. If patients requested, the dosage could be reduced to 40 mg per day but had to be escalated back to 60 mg per day within three weeks. Patients with at least one postbaseline assessment were included in the efficacy analysis. Greater reductions from baseline in HAMD17 scores were observed in patients receiving duloxetine than in those receiving placebo at the end of the study period. On secondary endpoints, duloxetine showed reduced pain and anxiety by week 9, but this finding was not significant.
Goldstein et al.[47] conducted a prospective, randomized, double-blind study comparing duloxetine 40 mg per day (20 mg twice daily) or duloxetine 80 mg per day (40 mg twice daily) with placebo or paroxetine 20 mg per day. The primary comparison was between the duloxetine 80-mg/day and placebo groups. There was no dosage adjustment period; all patients were initiated at and remained on the assigned dosage throughout the study period. At week 8, rates of remission in patients receiving duloxetine 80 mg per day (50%) were significantly greater than in those receiving duloxetine 40 mg per day (35%) or placebo (30%). Only patients receiving duloxetine 80 mg per day had significant reductions in overall pain severity (47% reduction). Also, on the HAMD17 subscale of anxiety, only the duloxetine 80-mg/day group achieved a significant reduction in anxiety or somatization.
Posted by Phillipa on December 25, 2005, at 19:38:04
In reply to Re: New PDoc RX'd High Dose Cymbalta, posted by inquisitive1 on December 25, 2005, at 11:29:28
Inquisitive, if I read that right it sounds promising. Both for anxiety/depression and pain. Did I read it right? Would you do it? Fondly, Phillipa
Posted by inquisitive1 on December 26, 2005, at 6:43:46
In reply to Re: New PDoc RX'd High Dose Cymbalta » inquisitive1, posted by Phillipa on December 25, 2005, at 19:38:04
Hi Phillipa,
I'm not certain as to how long you were on 60mg. I would think a two month trial would be adequate. I have a very bad heart condtion and my blood pressure jumped more than a few mm as indicated in the package insert so the drug is out for me. Buy a reliable blood pressure monitor and insist on liver enzyme tests periodically if you choose to go this route.
I hate to interfere with a doctor's rationale because I don't have all the facts. I wouldn't go to 120 mg if I felt I gave Cymbalta an adqequate and fair trial.
Posted by yxibow on December 27, 2005, at 0:25:36
In reply to Re: New PDoc RX'd High Dose Cymbalta, posted by inquisitive1 on December 26, 2005, at 6:43:46
> I hate to interfere with a doctor's rationale because I don't have all the facts. I wouldn't go to 120 mg if I felt I gave Cymbalta an adqequate and fair trial.It has been noted that the incidence of hypertension is only slightly above placebo for the range of 40-120/day
http://www.medscape.com/pages/sites/infosite/cymbalta-mdd/article-safetyAlso it has been mentioned, I forget where, another study about the pain and somatization of depression being helped by duloxetine, esp. at 80mg.
However this doesn't say that if you are experiencing consistent tachycardia and the only factor in your medication load has been the increase in Cymbalta, that one should continue at a higher dose, unless there is extreme reason for doing so. I would assume a beta blocker would be combined (other than propranolol, which tends to increase depression).
tidings
Posted by inquisitive1 on December 27, 2005, at 5:54:41
In reply to Re: New PDoc RX'd High Dose Cymbalta » inquisitive1, posted by yxibow on December 27, 2005, at 0:25:36
Thank you for your contribution yxibow. You just reminded me to take my propanolol.
This is the end of the thread.
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