![[dr. bob]](/dr-bob-sm.gif)
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 Pete1968 on January 15, 2009, at 17:29:26
Hi all, I was wondering if anyone else here has had experience of Duloxetine not working?
I have been taking 60mg Duloxetine for a month now after switching from Venlafaxine 150mg, and feel worse than I was on the Venlafaxine. I had hoped Duloxetine would be more effective than Venlafaxine (which I had been on for a year and found to be only partially effective). I thought these drugs were specifically aimed at treatment resistant depression, ie. more effective than standard SSRIs? My experiences with them lead me to believe that an SSRI such as Escitalopram works better for me in alleviating depressive symptoms, however I cannot tolerate the side effects of SSRIs specifically the gastro-intestinal upset.
Has anyone else tried these two SNRIs and found them ineffectual?
Posted by Reggie BoStar on January 15, 2009, at 19:17:48
In reply to Duloxetine ineffective?, posted by Pete1968 on January 15, 2009, at 17:29:26
I was put on Effexor (Duloxetine) for a while about 4 or 5 years ago, and it didn't really do much of anything for me - nothing I was aware of, at any rate. I was pretty sick with a lot of migraines, increased depression, constant sleeping, and various other problems. If the Effexor did something for me, I didn't notice it with all those other things going on.
Anyway, I was put on other things for some time and nothing really worked. Finally I was put on Cymbalta (Venlafaxine) just about when it first came out and I've been on it since. It had been working better for me in terms of depression until last Fall. Then it started losing effectiveness. The first few times I tried any SSRIs, starting with Prozac, the same thing happened, only a lot faster. The drug would improve things somewhat for a while, then stop working.
Cymbalta has lasted the longest so far. Now I'm on a mix of Cymbalta (lower dose than before) and Pristiq. The first sentence for Pristiq on Wikipedia is "Desvenlafaxine succinate, marketed under the name Pristiq, is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class from Wyeth. It is a metabolite of venlafaxine (Effexor). Pristiq is also being targeted as the first non-hormonal based treatment for menopause."
I was told that Pristiq is similar to Effexor XR, i.e. a time-release formula, but is supposed to have fewer side effects. I looked up "metabolite" and Wiki says that it is an intermediate of metabolism. Thus it seems that Pristiq is something like Effexor after the body has partially metabolized it. Maybe that's the theory behind the fewer side effects; those may have been caused during the initial stages of metabolozing Effexor. Those stages are now gone, ergo...
I went into that litany about Pristiq because you're now having negative experiences with Effexor. Who knows, maybe the "metabolite" form, Pristiq, might work better for you.
Of course it's all up to you and your pdoc. I don't even play either one of you on TV, so I can't be called qualified in any respect.
Besides, I'm a bad spokesperson for Pristiq anyway. I've been on it for almost 8 weeks now and so far it's done nothing. On the other hand, that also means it hasn't done anything negative. For what it's worth, I'm at least tolerating it.
I was on Lexapro (Escitalopram) for a very short time. It worked like Prozac: some improvement for a month or two, then nothing.
So, in summary (as usual), in order of application:
Effexor (Duloxetine): no effect I know of, but I was very sick and couldn't tell.
Lexapro (Escitalopram): some improvement for a month or two, then nothing.
Cymbalta (Venlafaxine): some improvement for 2-3 years, now wearing off.
Pristiq (Desvenlafaxine succinate, metabolite of Effexor): ???? Nothing after 8 weeks (so far).
Current doses: Cymbalta 30mg/day, Pristiq 50mg/day.
BTW I was never bothered by gastro problems on any of the SSRIs or SNRIs. What always got me was that they turned me into a mental and physical eunuch. I also had some problems with urinary retention. Cymbalta was the worst offender in that respect.
It almost seems as though the ED effect of these drugs affects my urethra sphinctor as well, rendering it very unresponsive. Fortunately for me, the default state is "closed". As bad as being catheterized is, I'd rather deal with that than incontinence.
I hope you can figure out whether or not I answered your question, because I sure can't.
Pristiq (Desvenlafaxine succinate, metabolite of Effexor): Memory problems, confusion.
Best wishes,
Reggie BoStar
Posted by SLS on January 15, 2009, at 19:37:12
In reply to Re: Duloxetine ineffective? » Pete1968, posted by Reggie BoStar on January 15, 2009, at 19:17:48
You might want to try adding desipramine to Pristiq. It could possibly add sufficient NE reuptake inhibition to help prevent poop-out. Tricyclics don't like to poop-out very often.
- Scott
Posted by linkadge on January 15, 2009, at 20:01:52
In reply to Re: Duloxetine ineffective? » Reggie BoStar, posted by SLS on January 15, 2009, at 19:37:12
The idea that SNRI's are more effective than SSRI's is somewhat of a controversial issue. Some meta-analysis do not support that conclusion.
I remember reading a study that suggested that venlafaxine was superior in effectivness to duloxetine. There are more actions of the medications than those stated on paper.
Linkadge
Posted by Larry Hoover on January 15, 2009, at 20:43:43
In reply to Re: Duloxetine ineffective? » Pete1968, posted by Reggie BoStar on January 15, 2009, at 19:17:48
> I was put on Effexor (Duloxetine)
> Finally I was put on Cymbalta (Venlafaxine)
> Cymbalta has lasted the longest so far.
> Effexor (Duloxetine): no effect I know of, but I was very sick and couldn't tell.
> Cymbalta (Venlafaxine): some improvement for 2-3 years, now wearing off.Reggie, I've edited you message to leave just these few passages.....you've confused the brand names and the generic drug names of Effexor and Cymbalta such that I'm not sure of what you're saying.
Effexor is venlafaxine, and Cymbalta is duloxetine.
Regards,
Lar
Posted by desolationrower on January 16, 2009, at 1:24:31
In reply to Re: Duloxetine ineffective? » Reggie BoStar, posted by Larry Hoover on January 15, 2009, at 20:43:43
If SSRIs worked, just with gastrointestinal problems, i'd probably try more creative antidotes for the side effect instead of findnig a new antidepressant. unless you've done that already.
-d/r
Posted by Phillipa on January 16, 2009, at 10:38:05
In reply to Re: Duloxetine ineffective?, posted by desolationrower on January 16, 2009, at 1:24:31
Couldn't tolerate effexor when first out but before menopause interesting as after menopause could tolerate 60mg of cymbalta but didn't notice anything still took my benzos but noticed when went off it had back pains and other pains so it must have worked for those. Interesting about the hormonal effects of pristig? Phiilipa
Posted by Pete1968 on January 16, 2009, at 12:05:08
In reply to Re: Duloxetine ineffective?, posted by desolationrower on January 16, 2009, at 1:24:31
Thank you all for replying, I am grateful for your views. Reggie BoStar, thank you for your input, I had never heard of the possibility combining the two SNRI meds before, I had always thought that wasnt really advisable, but then I am new to all this. Wouldnt combining Duloxetine and Venlafaxine run a risk of serotonin syndrome? I read up on Pristiq and it sees that it is essentially Venlafaxines metabolite, although I did benefit to a degree from Venlafaxine 150mg I didnt achieve full remission of symptom and decided to try Duloxetine 60mg in the hope that this would prove more potent, in the last 4 weeks I have actually felt worse than when I was taking Venlafaxine, I suppose I could always up the dose but I am a little concerned about increasing anxiety due to higher reuptake inhibition of Noradrenaline.
Its not that suffered 'poop out' with either drug, its just that I didnt feel like my MDD was sufficiently improved on the Venlafaxine, I have had experience with SSRIs including Escitalopram in the past (admittely not while severely depressed) and found them to improve mood more than SNRIs. However it was living with the constant diahorreah that made me quit in the end.
I take your point Desolationrower about treating the gastro side effects of SSRI use, it would be better to be less depressed and deal with it than the other way around.
And Linkadge, I am interested to know that the SNRI vs SSRI thing is disputed.
I can only assume from my personal experience that the serotonin blocking capabilities of SSRI's is more potent than SNRI's as SSRIS cause a notable increase in gastric peristalsis in me whereas the SNRIs do not. Apparently Serotonin is responsible for this.
I was wondering if anyone else has found Duloxetine (Cymbalta) to be ineffective in relieving symptoms of depression?
Posted by mav27 on January 16, 2009, at 12:42:34
In reply to Re: Duloxetine ineffective?, posted by Pete1968 on January 16, 2009, at 12:05:08
Duloxetine made me feel ok for about a week and then just made me feel nothing but tired for the next couple months until i gave up on it.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.