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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by hansi555 on September 24, 2008, at 1:37:34
Hi all
As I wrote a cpuple of weeks ago, I am considering to alter from my present combo - Lexapro 20 mg and Remeron 30 mg - to something else.I have most of the symptoms in Melancholic depression (morning worseness, early wake ups (somewhat prevented by the Remeron), loss of apetite during daytime, feeling better in the evening, off days w. crying spells).
Now my PD is suggesting Cymbalta to replace the Lexapro, What do you think about this?
I like the Remeron for the sleep and calm it gives me in the evening and would like to keep it but is this a good combo w. the Cymbalta?
Other suggestions or wievs?
Posted by azalea on September 24, 2008, at 17:43:51
In reply to More Melancholic depression - Cymbalta?, posted by hansi555 on September 24, 2008, at 1:37:34
I replied to your thread a couple weeks ago, but wanted to add that Cymbalta (like Effexor, both are SNRIs) is synergistic with Remeron. Cymbalta blocks the reuptake of both serotonin and norepinephrine. Remeron promotes the release of serotonin and norepinephrine. This is theoretically a powerful combo, providing a "double boost" of both serotonin and norepinephrine. I hope you find something that works.
Are you currently experiencing any side effects from the Lexapro or Remeron?
> Hi all
> As I wrote a cpuple of weeks ago, I am considering to alter from my present combo - Lexapro 20 mg and Remeron 30 mg - to something else.
>
> I have most of the symptoms in Melancholic depression (morning worseness, early wake ups (somewhat prevented by the Remeron), loss of apetite during daytime, feeling better in the evening, off days w. crying spells).
>
> Now my PD is suggesting Cymbalta to replace the Lexapro, What do you think about this?
>
> I like the Remeron for the sleep and calm it gives me in the evening and would like to keep it but is this a good combo w. the Cymbalta?
>
> Other suggestions or wievs?
Posted by bleauberry on September 24, 2008, at 20:22:12
In reply to More Melancholic depression - Cymbalta?, posted by hansi555 on September 24, 2008, at 1:37:34
Cymbalta...some people do absolutely amazing with it, some people do absolutely horrible with it, and a few people don't get much out of it either way. There is no way to tell without trying it.
While the psychiatric world puts labels on different types of depression, some of them mimic other conditions. In your case, you fit the description perfectly of a haywire adrenal system, likely adrenal fatigue. ADs that have norepinephrine reuptake inhibition (not norepinephrine stimulation/release) are good choices for that, as they supply the needed boost in NE, but at the same time create a feedback loop situation that helps over months to get the adrenal system back in balance. From personal experience the best med I've tried for that was Milnacipran, second best Cymbalta.
Too much of a norepinephrine dump all at once can make someone feel a lot worse, so go easy on starting doses and take your time. Adrenal/norepinephrine issues can get nasty if too much change happens too fast.
Posted by clipper40 on September 25, 2008, at 3:00:49
In reply to Re: More Melancholic depression - Cymbalta? » hansi555, posted by bleauberry on September 24, 2008, at 20:22:12
"...ADs that have norepinephrine reuptake inhibition (not norepinephrine stimulation/release) are good choices for that, as they supply the needed boost in NE, but at the same time create a feedback loop situation that helps over months to get the adrenal system back in balance. From personal experience the best med I've tried for that was Milnacipran, second best Cymbalta."
THANK YOU SO MUCH FOR THAT INFORMATIION! I didn't know that and was avoiding Milnacipran and any other NRI because of my adrenal fatigue. Do you know whether adding atenolol to keep my heart rate under control would negate that adrenal feedback loop? (I don't wish to hijack this thread so if you think this is off-topic, then I can post in a separate thread.)
Posted by hansi555 on September 25, 2008, at 14:17:04
In reply to Re: More Melancholic depression - Cymbalta? » hansi555, posted by azalea on September 24, 2008, at 17:43:51
Thanks for your reply
No not really, I have had problems w dizziness and nausea/lack of appetite. But I had these also before starting medicine. Also I cannot sleep in the afternoon, only after the remeron in the evening...
My main problem is having a bad start in the morning, sometimes I can somehow make it go away, sometimes it stays all day. Usually I feel good in the evening - especially right after taking the remeron, but then I get sleepy and go to bed -otherwise I can get really hungry.
But untill 3 days ago I was having a good period, only the first hour each morning was kinda "slow", then it was better in the first couple of hours and then good from midday and on.> I replied to your thread a couple weeks ago, but wanted to add that Cymbalta (like Effexor, both are SNRIs) is synergistic with Remeron. Cymbalta blocks the reuptake of both serotonin and norepinephrine. Remeron promotes the release of serotonin and norepinephrine. This is theoretically a powerful combo, providing a "double boost" of both serotonin and norepinephrine. I hope you find something that works.
>
> Are you currently experiencing any side effects from the Lexapro or Remeron?
>
> > Hi all
> > As I wrote a cpuple of weeks ago, I am considering to alter from my present combo - Lexapro 20 mg and Remeron 30 mg - to something else.
> >
> > I have most of the symptoms in Melancholic depression (morning worseness, early wake ups (somewhat prevented by the Remeron), loss of apetite during daytime, feeling better in the evening, off days w. crying spells).
> >
> > Now my PD is suggesting Cymbalta to replace the Lexapro, What do you think about this?
> >
> > I like the Remeron for the sleep and calm it gives me in the evening and would like to keep it but is this a good combo w. the Cymbalta?
> >
> > Other suggestions or wievs?
>
>
Posted by hansi555 on September 25, 2008, at 14:20:38
In reply to Re: More Melancholic depression - Cymbalta? » hansi555, posted by bleauberry on September 24, 2008, at 20:22:12
Milnacipran, never herd about, is it like Cymbalta or Effexor? Or something different?
I dont think it is on the Danish market...> Cymbalta...some people do absolutely amazing with it, some people do absolutely horrible with it, and a few people don't get much out of it either way. There is no way to tell without trying it.
>
> While the psychiatric world puts labels on different types of depression, some of them mimic other conditions. In your case, you fit the description perfectly of a haywire adrenal system, likely adrenal fatigue. ADs that have norepinephrine reuptake inhibition (not norepinephrine stimulation/release) are good choices for that, as they supply the needed boost in NE, but at the same time create a feedback loop situation that helps over months to get the adrenal system back in balance. From personal experience the best med I've tried for that was Milnacipran, second best Cymbalta.
>
> Too much of a norepinephrine dump all at once can make someone feel a lot worse, so go easy on starting doses and take your time. Adrenal/norepinephrine issues can get nasty if too much change happens too fast.
Posted by bleauberry on September 25, 2008, at 19:40:53
In reply to Re: More Melancholic depression - Cymbalta?, posted by hansi555 on September 25, 2008, at 14:20:38
> Milnacipran, never herd about, is it like Cymbalta or Effexor? Or something different?
> I dont think it is on the Danish market...
>It is a SNRI, except much stronger on norepinephrine than cymbalta or effexor.
The norepinephrine-to-serotonin ratios are approximately:
Effexor 1:30
Cymbalta 1:9
Milnacipran 3:1If it isn't on the Danish market, it is nearby. It is from Europe and Japan primarily. Many people get it from mailorder pharmacies or anti-aging places in United Kingdom.
Posted by hansi555 on September 26, 2008, at 2:57:39
In reply to Re: More Melancholic depression - Cymbalta? » hansi555, posted by bleauberry on September 25, 2008, at 19:40:53
> > Milnacipran, never herd about, is it like Cymbalta or Effexor? Or something different?
> > I dont think it is on the Danish market...
> >
>
> It is a SNRI, except much stronger on norepinephrine than cymbalta or effexor.
> The norepinephrine-to-serotonin ratios are approximately:
> Effexor 1:30
> Cymbalta 1:9
> Milnacipran 3:1
>
> If it isn't on the Danish market, it is nearby. It is from Europe and Japan primarily. Many people get it from mailorder pharmacies or anti-aging places in United Kingdom.
I have read a lot scary stuff regarding withdrawal symptoms for Cymbalta.So I am also concidering to go for a TCA instead, Nortriptylin (Pamelor) as this should also be well for treating Melancholic symptoms.
Havent read much about withdrawal problems with Nortriptylin, but maybe I am wrong...?Which one is the best choice? I know it is a tough call, but I dont like the idea of becoming addictive to ADs like Cymbalta
Posted by azalea on September 26, 2008, at 16:37:27
In reply to Re: More Melancholic depression - Cymbalta or TCA, posted by hansi555 on September 26, 2008, at 2:57:39
Rest assured Cymbalta is not addictive. There is a discontinuation syndrome that occurs when you stop taking it, but this can be minimized by tapering the dose. Discontinuation syndrome also occurs with TCAs like Pamelor.
>
> I have read a lot scary stuff regarding withdrawal symptoms for Cymbalta.
>
> So I am also concidering to go for a TCA instead, Nortriptylin (Pamelor) as this should also be well for treating Melancholic symptoms.
> Havent read much about withdrawal problems with Nortriptylin, but maybe I am wrong...?
>
> Which one is the best choice? I know it is a tough call, but I dont like the idea of becoming addictive to ADs like Cymbalta
>
This is the end of the thread.
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