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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Simcha on December 14, 2006, at 0:19:37
Well folks, I haven't written in a long time. I've been euthymic for the most part since I've written. It's been at least a year, I think.
The depression is back. It's all the same junk, only this time Fibromyalgia complicates it. My pdoc does both psychiatry and pain management, yet he says that he can't do both at the same time. He says it's a conflict, ethically. I don't know if there's some sort of California law or what...
Anyway, since he's been my psychiatrist for years he's staying my psychiatrist. My regimen has been the following for a few years:
40mg Celexa (Citalopram) in the am
400mg Wellbutrin XL (Buproprion) in the pm
600mg Neurontin (Gabapentin) in the pmHe says that the latest studies suggest that Effexor (Venlafaxine) and Cymbalta (Duloxetine) not only work for depression, they also work on Fibromyalgia related pain. My background daily pain is a 5 out of 10 (10 being the most pain). He says he has to address this with antidepressants because the pain can cause depression (d'uh!).
Also my father died 5/9/2006. Yes I'm still in mourning and yet I'm having symptoms of depression now and I needed to do something about it besides just talk therapy.
Anyway. He asked me to increase the Neurontin (originally for bruxism 'grinding teeth while sleeping') to 300mg 4x daily. He says that not only can it help me through the transition from Wellbutrin and Celexa to Cymbalta, but it can help with the Fibromyalgia pain. He'd like to put me on Lyrica (Pregabalin) instead of Neurontin for the Fibromyalgia pain but he can't do it since it's not indicated for anything psychiatric so my GP will have to prescribe it, if my GP agrees to switch me from Neurontin to Lyrica. Ugh!
Anyway, first he's going to wean me off of Celexa while increasing the dose of Cymbalta up to a therapeutic level. Then he says we can work on taking me off of the Wellbutrin.
I'm less than excited about this med change. I'm less than excited about anything these days, because I'm so depressed.
I'm also angry that I have to go through a med change and that the depression is back even though I'm already on meds and have been on meds for 5+ years for depression. I thought that perhaps I wouldn't need meds in a few years if my depression didn't return. I guess that's not the case.
Also, I've gained weight and I sweat a lot on these darn meds. He said that the sweating won't likely change and that the Neurontin could continue to make me gain weight. He did say that getting off of the Celexa might help stabilize my weight though. I'm skeptical.
I suppose though that if I can get the depression and the fibromyalgia under control that I would have enough energy to do more walking. And I wouldn't be in too much pain to walk any distance.
All of this is so frustrating. I hate that the depression is back. I thought I was doing so well in mourning my father without getting depressed. Well I was wrong.
Well, I'm back for now and will check in to let people know how this is going. It's going to take a couple of months at least because I go to Chicago for two weeks to visit my mother and brother in the beginning of January (I'm originally from Chicago... Been in Oakland, CA for over 4 and a half years.)
Simcha
Posted by stargazer on December 14, 2006, at 1:00:19
In reply to Switching to Cymbalta... Depressed Again, posted by Simcha on December 14, 2006, at 0:19:37
Sorry to hear of your relapse...It s**ks doesn't it?
I also lost my father this past year (Jan) and this has been a really tough year for me as well.
My father was the most positive person in my life and I guess I'm lucky I had him as long as I did but it doesn't make it any easier.I wish you luck with your med changes...this year I went from Celexa, Wellbutrin and Adderal, to Celexa, Wellbutrin and Lamictal, to Marplan (my request)and Lamictal, to Lamictal alone, to Cymbalta, to Seroquel, to Emsam, which I have been on for the past month. Depression is on a steady course right now. Keeping fingers crossed...
Life is so difficult at times but you will get through it. Loss certainly does complicates things though.
Stargazer
Posted by Maxime on December 14, 2006, at 1:29:30
In reply to Switching to Cymbalta... Depressed Again, posted by Simcha on December 14, 2006, at 0:19:37
I'm sorry to hear everything is so bad for you right now.
Amitriptyline, a tricyclic, is good for pain disorders and depression. You might want to give it a go. Just thought you might like to know.
Take care.
Maxie
> Well folks, I haven't written in a long time. I've been euthymic for the most part since I've written. It's been at least a year, I think.
>
> The depression is back. It's all the same junk, only this time Fibromyalgia complicates it. My pdoc does both psychiatry and pain management, yet he says that he can't do both at the same time. He says it's a conflict, ethically. I don't know if there's some sort of California law or what...
>
> Anyway, since he's been my psychiatrist for years he's staying my psychiatrist. My regimen has been the following for a few years:
>
> 40mg Celexa (Citalopram) in the am
> 400mg Wellbutrin XL (Buproprion) in the pm
> 600mg Neurontin (Gabapentin) in the pm
>
> He says that the latest studies suggest that Effexor (Venlafaxine) and Cymbalta (Duloxetine) not only work for depression, they also work on Fibromyalgia related pain. My background daily pain is a 5 out of 10 (10 being the most pain). He says he has to address this with antidepressants because the pain can cause depression (d'uh!).
>
> Also my father died 5/9/2006. Yes I'm still in mourning and yet I'm having symptoms of depression now and I needed to do something about it besides just talk therapy.
>
> Anyway. He asked me to increase the Neurontin (originally for bruxism 'grinding teeth while sleeping') to 300mg 4x daily. He says that not only can it help me through the transition from Wellbutrin and Celexa to Cymbalta, but it can help with the Fibromyalgia pain. He'd like to put me on Lyrica (Pregabalin) instead of Neurontin for the Fibromyalgia pain but he can't do it since it's not indicated for anything psychiatric so my GP will have to prescribe it, if my GP agrees to switch me from Neurontin to Lyrica. Ugh!
>
> Anyway, first he's going to wean me off of Celexa while increasing the dose of Cymbalta up to a therapeutic level. Then he says we can work on taking me off of the Wellbutrin.
>
> I'm less than excited about this med change. I'm less than excited about anything these days, because I'm so depressed.
>
> I'm also angry that I have to go through a med change and that the depression is back even though I'm already on meds and have been on meds for 5+ years for depression. I thought that perhaps I wouldn't need meds in a few years if my depression didn't return. I guess that's not the case.
>
> Also, I've gained weight and I sweat a lot on these darn meds. He said that the sweating won't likely change and that the Neurontin could continue to make me gain weight. He did say that getting off of the Celexa might help stabilize my weight though. I'm skeptical.
>
> I suppose though that if I can get the depression and the fibromyalgia under control that I would have enough energy to do more walking. And I wouldn't be in too much pain to walk any distance.
>
> All of this is so frustrating. I hate that the depression is back. I thought I was doing so well in mourning my father without getting depressed. Well I was wrong.
>
> Well, I'm back for now and will check in to let people know how this is going. It's going to take a couple of months at least because I go to Chicago for two weeks to visit my mother and brother in the beginning of January (I'm originally from Chicago... Been in Oakland, CA for over 4 and a half years.)
>
> Simcha
Posted by Phillipa on December 14, 2006, at 12:01:06
In reply to Re: Switching to Cymbalta... Depressed Again » Simcha, posted by Maxime on December 14, 2006, at 1:29:30
Glad you had a good year until lately. But the only thing I noiticed when I took cymbalta the first time that pain was gone. Didn't know till stopped and I had backpain. Love Phillipa
Posted by Simcha on December 15, 2006, at 1:12:41
In reply to Re: Switching to Cymbalta... Depressed Again, posted by Phillipa on December 14, 2006, at 12:01:06
Thanks for the responses.
OK, I'm on day 2 of 30mg of Cymbalta + increasing the Neurontin to 1,200mg per day. I'm still on the 40mg of Celexa and the 400mg of Wellbutrin XL.
I'm not having any negative side effects. Per pdoc's orders I'm increasing to 60mg of Cymbalta and decreasing the Celexa to 20mg.
I'm still depressed, of course. I still have pain, of course. It's not long enough to know if the Cymbalta is doing anything, also considering all the other meds I'm on.
I'm still angry that I need to switch. To add insult to injury, I just found out that Cymbalta is not on my PPO's formulary. At least it's only a $35 co-pay for non-formulary drugs on the plan. It's still a heck of a lot more than the brand co-pay of $20 and a far cry from the generic $10 co-pay. Of course, the other option was Effexor XR, that would be a $20 co-pay.
I guess I shouldn't complain, because I'm aware that many on this board don't have health insurance, due to the sad state of health care in the USA.
The only thing is that my first med was Effexor XR. While being great for the depression, it was terrible for making me completely impotent. Also it was terrible to withdraw from.
I could go into a rant about the state of health care in our country (USA) and how darn expensive it is. I could launch into a rant about how inaccessable health care is for many in our country and one of the reasons is the high cost, even if you have insurance. (Greedy darn American insurance companies! Umph!) But, alas, that might be for another board.
It certainly doesn't help my depression to be barely able to afford my life. Geez, I'm hearing another Cymbalta commercial on the TV again. I wonder how much those darn commercials add to the price of Cymbalta?... Gee, I wonder...
Did I mention that I've had agitated depression?
I'm a psychotherapist intern and I make a very low salary at it because we don't value our youth or anyone's mental health in this country. I qualify for section 8 housing on the salary I get (Section 8 is assisted housing for low-income earners.) In Cali it isn't difficult to be at a job that doesn't pay enough to meet basic, and I mean BASIC, expenses.
At least I can work. I tend to be high functioning even when moderately to severely depressed. I just have a strong will, that's all. It gets me into trouble in that I can grit my teeth through more pain than most, so I often don't recognize that I'm in pain (emotional and physical) until it gets very bad.
I hope these med changes I'm going through bring some sort of relief for all the expense and the trouble that it causes me.
Simcha
Posted by SLS on December 15, 2006, at 5:55:31
In reply to Re: Switching to Cymbalta... Depressed Again, posted by Simcha on December 15, 2006, at 1:12:41
For what it's worth, on paper, it sounds like your doctor is doing a good job.
It's a little out there, but there is a Dr. Peter Mueller in Princeton, NJ who reports having success with sibutramine (Meridia) for treating fibromyalgia and associated mood disturbances. Sibutramine, like Effexor and Cymbalta, is a reuptake inhibitor of serotonin and norepinephrine. However, its metabolites also inhibit the reuptake of dopamine. The drug is normally used to treat obesity.
- Scott
Posted by Simcha on December 15, 2006, at 10:21:20
In reply to Re: Switching to Cymbalta... Depressed Again, posted by SLS on December 15, 2006, at 5:55:31
Thanks SLS,
I'm taking the 60mg of Cymbalta this am and reducing the Celexa to 20mg.
Yeah, I think my pdoc is competent. I have hope. Thanks for the responses.
Simcha
Posted by Simcha on December 15, 2006, at 13:48:07
In reply to Re: Switching to Cymbalta... Depressed Again » SLS, posted by Simcha on December 15, 2006, at 10:21:20
This is day 3 adding Cymbalta to my regimen. Days 1 and 2 were about taking 30mg in the morning and keeping steady on all other meds except Neurontin which I increased (a fairly easy transition to make, the Neurontin.)
Day 3 - I took 60 mg Cymbalta this morning and reduced the Celexa to 20mg.
I'm feeling spacey. Yet I don't know if it's still just the depression because the latest bought of depression/fibromyalgia has included mental fog. I hate it. I struggle for words sometimes and I lose my train of thought. I hope all of this goes away soon.
Simcha
Posted by Sonny Liston on December 18, 2006, at 12:26:40
In reply to Re: Switching to Cymbalta... Report, posted by Simcha on December 15, 2006, at 13:48:07
Simcha,
How are you making out on day 6?
> This is day 3 adding Cymbalta to my regimen. Days 1 and 2 were about taking 30mg in the morning and keeping steady on all other meds except Neurontin which I increased (a fairly easy transition to make, the Neurontin.)
>
> Day 3 - I took 60 mg Cymbalta this morning and reduced the Celexa to 20mg.
>
> I'm feeling spacey. Yet I don't know if it's still just the depression because the latest bought of depression/fibromyalgia has included mental fog. I hate it. I struggle for words sometimes and I lose my train of thought. I hope all of this goes away soon.
>
> Simcha
Posted by Simcha on December 18, 2006, at 20:05:58
In reply to Re: Switching to Cymbalta... Report, posted by Sonny Liston on December 18, 2006, at 12:26:40
Sonny and All,
I'm on day 6 and I'm not having any adverse reactions. The depression is no better and I'm still having some mental fog and I'm still in pain.
I called my pdoc to give a report and he said that I'm doing as expected. No drug works in 6 days, etc. I'm getting off of the Celexa in the next couple of days.
So tomorrow morning it's:
10mg Celexa (Down from 20 today)
60mg CymbaltaThen... Early evening,
300mg Neurontin
Then... Before bed,
900mg Neurontin
300mg Wellbutrin XLThe pdoc is confident that there is enough seratonin reuptake inhibition with the Cymbalta that I should be able to stop the Celexa altogether after only a few days at 10mg. This is the last change he's going to make until I get back from Chicago on Jan. 15th and will see him on January 16th at 9am. Then he will be able to evaluate whether or not I need to go up to 90mg Cymbalta or possibly 120mg. (120mg being the dose for neuropathy and might be needed for my fibromyalgia pain)
Then he can see what we shall do with the Wellbutrin. I'm not sure I can stay on the Wellbutrin if I stabilize on Cymbalta, I'm not sure. Would I get too much norepinephrine?
I would love to have one less co-pay per month if I can be euthymic and pain-free on only 2 meds. But we shall see...
Simcha
Posted by Simcha on December 20, 2006, at 10:37:19
In reply to Re: Switching to Cymbalta... Report » Sonny Liston, posted by Simcha on December 18, 2006, at 20:05:58
So today is day 8.
I woke up with a tickle in my throat. The pdoc says that discontinuation of Celexa could cause flu like symptoms. So, is this the discontinuation or a cold coming on? It's been chilly here lately. Either way, I don't like it.
I'm not having any other side effects from the med change so far. No relief from the depression. I think I'm starting to feel some pain relief. Is it the Neurontin? Is it the Cymbalta? Or is it just part of the fibromyalgia cycle?
I wish I weren't depressed. I have way too much to do at work to not function at 100%.
This morning I took:
60mg Cymbalta
10mg CelexaThis evening I'll take:
300mg NeurontinBefore bed I'll take:
900mg Neurontin
300mg Wellbutrin XLSimcha
Posted by Simcha on December 21, 2006, at 15:37:26
In reply to Re: Switching to Cymbalta... Report, posted by Simcha on December 20, 2006, at 10:37:19
I'm still on the same meds at the same dosages as yesterday.
I felt a little improvement in mood yesterday mis-morning after I wrote the report for yesterday.
Today I'm finding that I'm agitated at drivers more than usual and I'm more a aggressive driver. Actually, I get around better, this is the Bay Area and people drive like, well, you know, here.
It's nice to feel something, even if it's agitation.
However, I'm kind of dead below the waist (male). I don't know if it's the depression or if it's the med change. Also, I've heard that sometimes the sexual SEs of a med will come at first and can go away. I remember that Effexor XR was that way for a while until the sexual SEs came back and I had to get off of it. One would think that the Wellbutrin XL would take care of the sexual SEs.
Tomorrow will be my last day of taking Celexa. I've been on it for years. I hope this med change works.
Simcha
Posted by Simcha on December 24, 2006, at 1:13:47
In reply to Re: Switching to Cymbalta... Report Day 9, posted by Simcha on December 21, 2006, at 15:37:26
OK, today is the first day without any Celexa. So my regimen looks like this:
AM
60mg CymbaltaAfternoon/Evening
300mg NeurontinBefore Bed:
900mg Neurontin
300mg Wellbutrin XLI'm still having some depression. I think I'm having less fibromyalgia pain.
Right now I have a bad cold that has messed everything up. I think it's just a bad cold and not discontinuation from Celexa.
I'm sitting at my desk feeling kind of woosey... It's probably the cold.
So far I'd have to say that Cymbalta hasn't messed me up. I don't know if it's going to help or not yet. I hope that I have more to report, like improvements soon.
Simcha
Posted by SLS on December 24, 2006, at 5:48:12
In reply to Re: Switching to Cymbalta... Report Day 11, posted by Simcha on December 24, 2006, at 1:13:47
> So far I'd have to say that Cymbalta hasn't messed me up. I don't know if it's going to help or not yet. I hope that I have more to report, like improvements soon.
Sounds encouraging, especially with the abatement in the fibromyalgia.
- Scott
Posted by Simcha on December 25, 2006, at 2:26:08
In reply to Re: Switching to Cymbalta... Report Day 11 » Simcha, posted by SLS on December 24, 2006, at 5:48:12
Scott,
I think it's helping with the pain. It's hard to tell since I've got this bad cold still.
Day 12 was spent getting over this cold. I feel kind of woosy right now. I don't know if it's the cold medicine or the Cymbalta + no Celexa.
Simcha
Posted by Simcha on December 27, 2006, at 23:03:53
In reply to Re: Switching to Cymbalta... Report Day 12 » SLS, posted by Simcha on December 25, 2006, at 2:26:08
OK,
I really couldn't sleep last night. I'm only somewhat tired today. I'll take an AmbienCR tonight to induce sleep.
Also, I'm not hungry at all and when I eat I'm full almost right away. This morning I had coffee and a scone. This afternoon I had an orange. Tonight, for the big meal, I had an avocado, a few slices of cheese, and some pretzels...And I'm stuffed!
I'm a big guy. I'm 270 lbs. (gained like 70 pounds in the past 5 years on meds) My best weight should probably be close to 200 lbs. I'm 5'10" with a barrel chest, thick arms and legs...Still have lots of muscle... And I'm usually HUNGRY, so HUNGRY. But, for the past few days my appetite is disappearing and today it's almost non-existent. I have quite a lot of extra fat to live off of for a long while yet, so no worries. I wonder if the Celexa was making me eat and crave carbs?
It's the darndest thing... Food still tastes good yet I'm not hungry, really at all.
Also, I seem to have a buzzy-like energy most of the day. It's kind of weird. I'm not high exactly. Of course, during this latest round of depression I've had NO energy, so I welcome it.
I'm starting to feel more like myself, only peppier, less hungry, and I'm having less pain.
So, my current regimen is:
AM:
60mg CymbaltaAfternoon/Evening:
300mg Neurontin (as needed)Before bed:
900mg Neurontin
300mg Wellbutrin XL (I take it at night because for some reason it was too stimulating later on in the evening if I took it in the morning... Hmmm, I wonder of Cymbalta is like that?)So, is Cymbalta a stimulant or was Celexa really sucking my energy away and making me eat, craving carbs?
Simcha
Posted by Phillipa on December 27, 2006, at 23:08:14
In reply to Is Cymbalta A Stimulant? Report Day 14, posted by Simcha on December 27, 2006, at 23:03:53
Cymbalta usually in the am. And celexa drained me. According to other babblers it's good that things taste better to you as I lost my taste and the others said it's depression. May I ask what the neurotin is for? Thanks Phillipa
Posted by Simcha on December 27, 2006, at 23:26:05
In reply to Re: Is Cymbalta A Stimulant? Report Day 14 » Simcha, posted by Phillipa on December 27, 2006, at 23:08:14
Phillipa,
> May I ask what the neurotin is for?
Certainly. The Neurontin is for low-level anxiety, restless legs syndrome, and bruxism (teeth grinding while sleeping). It works for all three for me. It also allegedly helps with pain.
Simcha
Posted by Phillipa on December 27, 2006, at 23:38:57
In reply to Re: Is Cymbalta A Stimulant? Report Day 14 » Phillipa, posted by Simcha on December 27, 2006, at 23:26:05
So the neurotin wouldn't work for long term anxiety that I've taken benzos for years for? And wouldn't help sleep? Thanks Phillipa
Posted by Simcha on December 28, 2006, at 1:07:06
In reply to Re: Is Cymbalta A Stimulant? Report Day 14 » Simcha, posted by Phillipa on December 27, 2006, at 23:38:57
> So the neurotin wouldn't work for long term anxiety that I've taken benzos for years for? And wouldn't help sleep? Thanks Phillipa
Phillipa,
I don't know if it would work for you. I do know that Neurontin helps for my anxiety. I don't have GAD or SA though... Not sure what your diagnosis is. I have Major Depressive Disorder with Recurrence. The Neurontin does help with sleep. It is a hypnotic. It doesn't work as well as the Ambien CR I take, but it takes the edge off and helps me calm to get in the mood to sleep.
Simcha
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