![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Frustratedmama on April 12, 2010, at 14:48:27
So far i have tried taking 30 mg twice a day, taking 60 mg in AM, then now taking 60 mg in the PM....STILL VERY TIRED.....waking up at night....wanting to nap (sometimes NEED to nap).
ALso taking adderall XR 15 mg and Librium 5 mg during the day and antihistamine at night
Tried not taking adderall for a couple of days and was not able to do anything.....
Suggestions and questions for you all are:
1)Does cymbalta become more energizing and less fatiguing at higher or lower doses? Would it be better to increase or decrease the dose?
2) Any other changes or adjunct meds to combat the side effects of apathy, lethargy, and fatigue I am feeling?
I like the way cymbalta helps the irritability so want to keep the positive but combat the negative....
Please feel free to suggest anything that might work!
THANKS IN ADVANCE!
Posted by Phillipa on April 12, 2010, at 16:42:17
In reply to Cymbalta- dose related fatigue? or adjunct meds?, posted by Frustratedmama on April 12, 2010, at 14:48:27
Could it be you could do as well on a lower dose of cymbalta? If not maybe eliminate the librium and the antihistamine. Or if need for sleep can you up your stimulant. What about providgil? Phillipa
Posted by Frustratedmama on April 12, 2010, at 19:06:13
In reply to Re: Cymbalta- dose related fatigue? or adjunct meds? » Frustratedmama, posted by Phillipa on April 12, 2010, at 16:42:17
Thanks Phillipa,
I can't eliminate the antihistamine (it's for allergies) and the librium really does help take the final edge off- however, I do think I could tweak the cymbalta dose so hopefully that will work....just wondering if going up or down is a better choice.....
Posted by Lou Pilder on April 12, 2010, at 19:33:19
In reply to Cymbalta- dose related fatigue? or adjunct meds?, posted by Frustratedmama on April 12, 2010, at 14:48:27
> So far i have tried taking 30 mg twice a day, taking 60 mg in AM, then now taking 60 mg in the PM....STILL VERY TIRED.....waking up at night....wanting to nap (sometimes NEED to nap).
>
> ALso taking adderall XR 15 mg and Librium 5 mg during the day and antihistamine at night
>
> Tried not taking adderall for a couple of days and was not able to do anything.....
>
> Suggestions and questions for you all are:
>
> 1)Does cymbalta become more energizing and less fatiguing at higher or lower doses? Would it be better to increase or decrease the dose?
>
> 2) Any other changes or adjunct meds to combat the side effects of apathy, lethargy, and fatigue I am feeling?
>
> I like the way cymbalta helps the irritability so want to keep the positive but combat the negative....
>
> Please feel free to suggest anything that might work!
>
> THANKS IN ADVANCE!FM,
You wrote,[...questions for you all..feel free to suggest anything...]
My suggestion to you is to read the reports in the link here. The reports are about real world events from those using Cymbalta after the drug had been on the market for some time. The reports in the link are only the deaths that the doctors think were associated in some way with that the person that died was using Cymbalta. There are other deaths in the repots that the person that died also used other psychotropic drugs. Some of the deaths were completed suicides by gunshot. There are 5 pages of 102 deaths that the doctors reporting those deaths thought that Cymbalta was in associtaion with what caused the person to kill themselves or died from other causes that they think had an association with Cymbalta use.
So my suggestion is to read the reports in the link so that you could maybe have a better understanding of the potential for the drug Cynbalta to kill you or create some mind-alterd state that could lead you to believe that you should kill yourself, if you have not already read these facts.
Lou
http:// www.druglib.com/adverse-reactions_side-effects/cymbalta/seriousness_death
Posted by Lou Pilder on April 12, 2010, at 19:51:33
In reply to Lou's response- » Frustratedmama, posted by Lou Pilder on April 12, 2010, at 19:33:19
> > So far i have tried taking 30 mg twice a day, taking 60 mg in AM, then now taking 60 mg in the PM....STILL VERY TIRED.....waking up at night....wanting to nap (sometimes NEED to nap).
> >
> > ALso taking adderall XR 15 mg and Librium 5 mg during the day and antihistamine at night
> >
> > Tried not taking adderall for a couple of days and was not able to do anything.....
> >
> > Suggestions and questions for you all are:
> >
> > 1)Does cymbalta become more energizing and less fatiguing at higher or lower doses? Would it be better to increase or decrease the dose?
> >
> > 2) Any other changes or adjunct meds to combat the side effects of apathy, lethargy, and fatigue I am feeling?
> >
> > I like the way cymbalta helps the irritability so want to keep the positive but combat the negative....
> >
> > Please feel free to suggest anything that might work!
> >
> > THANKS IN ADVANCE!
>
> FM,
> You wrote,[...questions for you all..feel free to suggest anything...]
> My suggestion to you is to read the reports in the link here. The reports are about real world events from those using Cymbalta after the drug had been on the market for some time. The reports in the link are only the deaths that the doctors think were associated in some way with that the person that died was using Cymbalta. There are other deaths in the repots that the person that died also used other psychotropic drugs. Some of the deaths were completed suicides by gunshot. There are 5 pages of 102 deaths that the doctors reporting those deaths thought that Cymbalta was in associtaion with what caused the person to kill themselves or died from other causes that they think had an association with Cymbalta use.
> So my suggestion is to read the reports in the link so that you could maybe have a better understanding of the potential for the drug Cynbalta to kill you or create some mind-alterd state that could lead you to believe that you should kill yourself, if you have not already read these facts.
> Lou
> http:// www.druglib.com/adverse-reactions_side-effects/cymbalta/seriousness_deathhttp://www.druglib.com/adverse-reactions_side-effects/cymbalta/seriousness_death/
Posted by Phillipa on April 12, 2010, at 21:32:56
In reply to Re: Lou's response-correction to link, posted by Lou Pilder on April 12, 2010, at 19:51:33
Lou is this really helpful to the inquiring poster who already is in emotional pain. These others in the link some could have been in very bad health or taking the wrong med combos for them. Phillipa
Posted by Lou Pilder on April 12, 2010, at 22:38:08
In reply to Re: Lou's response-correction to link » Lou Pilder, posted by Phillipa on April 12, 2010, at 21:32:56
> Lou is this really helpful to the inquiring poster who already is in emotional pain. These others in the link some could have been in very bad health or taking the wrong med combos for them. Phillipa
Phillipa,
You wrote,[...to the inquiering poster...could have...wrong med combos...]
I was responding to the poster's invitation to feel free to suggest anything.
My suggestion to read what is in the link is for education concerning the drug that the member states is being taken. The forum is for education here about what is called here medicines. The aspect that that drug could cause death by suicide or by other means is as important IMO as any other aspect of this forum.
Now I want to save lives here and the drug in question is listed with others in a lot of those reported deaths in the link. So by seeing those, one could determine if the combination that they are takijng also has the potential to cause death or a mind-alterd state that could cause one to think of killing themselves. I think that saving a life is a higher priority here than any other thing anyone here wants to say about my efforts to help members learn of the consequences to taking psychotropic drugs as to that they can cause sudden death and suicde thoughts.
By reading that link one could take it back to the doctor that prescribed the drug and ask questions before they might suddenly die or think of killing themselves or even killing others. How many have killed themselves here? How many could have been still alive if I could have posted that link earlier? How many could be free from addiction if I was allowed to post the foundation of my faith here? How many could be free from addiction if I was allowed to show what the bible teaches about drugs? How many will die here because I am not allowed to show what the faith that uses the bible teaches about drugs? If more people die here from drugs and suicide, and someone greater than me asks people here if they tried to help them, who could say that they did? I could.
Lou
Posted by Phillipa on April 12, 2010, at 23:40:47
In reply to Re: Cymbalta- dose related fatigue? or adjunct meds?, posted by Frustratedmama on April 12, 2010, at 19:06:13
Frustratedmama I took cymbalta 60mg without problems and no suicidal ideation, attempts, no thoughts of murder, I combined at the time with two different benzos and chloral hydrate which some say could be dangerous. I was fine. No side effects either. Wierd wasn't tired. You would have thought this would tire me greatly. But I went to the gym daily lifted weights, did the eliptical. Then in the afternoon walked five vigorous miles on the beach. Then at home rode my bike about 14 miles a day, walked the dogs. We do all respond to meds differently that's for sure with your response. After three months I came off cymbalta also with no withdrawal and switched back to low dose luvox where I remain to this day. But I'm no longer using chloral hydrate. Quit that about five years ago no problem. And this is the 40th year of benzos for me different doses depending on stress in life at different time never increased. It's been less and less as years go on. Feel free to babblemail me since yours isn't on. Oh and when I stopped the cymbalta I found out that it had deadened my body back pain. Great for pain. Love Phillipa
Posted by SLS on April 13, 2010, at 7:04:54
In reply to Lou's reply-eighkod » Phillipa, posted by Lou Pilder on April 12, 2010, at 22:38:08
It is scary to read a few stories on the Internet. However, there are no statistics offered to suggest how often such things happen. Any study into this would have to correct for the number of depressed people who would go on to attempt suicide in the absence of treatment.
- Scott
Posted by Frustratedmama on April 13, 2010, at 18:03:21
In reply to Cymbalta- dose related fatigue? or adjunct meds?, posted by SLS on April 13, 2010, at 7:04:54
I read the posts and link and will discuss with pdoc tomorrow. I am currently doing better on the cymbalta with the exception of the fatigue. May consider lowering the dose....or increasing....
I was trying to figure out if increasing dose would help increase NE and thus cause less fatigue or if it would increase the SSRI effect and cause more fatigue.....anyone have thoughts on this?
Posted by SLS on April 14, 2010, at 7:03:09
In reply to Thank you - one more question......., posted by Frustratedmama on April 13, 2010, at 18:03:21
> I read the posts and link and will discuss with pdoc tomorrow. I am currently doing better on the cymbalta with the exception of the fatigue. May consider lowering the dose....or increasing....
>
> I was trying to figure out if increasing dose would help increase NE and thus cause less fatigue or if it would increase the SSRI effect and cause more fatigue.....anyone have thoughts on this?I suspect that fatigue is a common side effect with Cymbalta, but less so with Effexor and Savella. Perhaps adding Concerta would help.
- Scott
Posted by Lou Pilder on April 14, 2010, at 9:25:01
In reply to Thank you - one more question......., posted by Frustratedmama on April 13, 2010, at 18:03:21
> I read the posts and link and will discuss with pdoc tomorrow. I am currently doing better on the cymbalta with the exception of the fatigue. May consider lowering the dose....or increasing....
>
> I was trying to figure out if increasing dose would help increase NE and thus cause less fatigue or if it would increase the SSRI effect and cause more fatigue.....anyone have thoughts on this?FM,
YOu wrote,[...anyone have any thoughts...(fatigue)...]
There is a reply to you here writing about a drug that is a formulation of methylphenidate. That chemical is chemically a chain substituted amphetamine derivative related to cocaine and combined with other drugs could cause adverse reactions.
You asked about member's thoughts. I am thinking that you have a long conversation with whoever is prescribingg these drugs to you ans ask them the following:
A. What is the probability of me to suddenly stop breathing, such as from my heart stopping, from taking these chemicals into my nervous system?
B. Will I have to take these drugs for life unless I want to go through withdrawal from them?
C. What evidence could you give to me that I have a chemical imbalance and taking these drugs will correct this imbalance?
D. Does this mean that my brain is deficiant in Cymbalta?
E. Why is it illegal in Ireland for the drug makers to say in the package insert to these drugs that there is a chemical imbalance that the drug will be used for?
F. If these drugs are addictive, why are they legal to sell when, let's say, cocaine as an example, is not?
G. If around 36,000 people die per year in the U.S. alone from related psychotropic drug issues, which means that world-wide it is likely that 300,000 die each year which could mean that millions of people could die from related issues with these drugs in the decades ahead, and that millions have died already from issues related from these drugs, how could these chemicals, in your opinion, be allowed to be sold?
E. Will the drug company provide me with compensation from any pain/suffering if I have to go thriough a withdrawal period?
F. If I die suddenly from these drugs that you prescribe to me, will you compensate my survivors for the grief that they could experiance and for the loss of me from them?
Lou
Posted by Lou Pilder on April 14, 2010, at 15:30:08
In reply to Lou's response-anythoughts » Frustratedmama, posted by Lou Pilder on April 14, 2010, at 9:25:01
> > I read the posts and link and will discuss with pdoc tomorrow. I am currently doing better on the cymbalta with the exception of the fatigue. May consider lowering the dose....or increasing....
> >
> > I was trying to figure out if increasing dose would help increase NE and thus cause less fatigue or if it would increase the SSRI effect and cause more fatigue.....anyone have thoughts on this?
>
> FM,
> YOu wrote,[...anyone have any thoughts...(fatigue)...]
> There is a reply to you here writing about a drug that is a formulation of methylphenidate. That chemical is chemically a chain substituted amphetamine derivative related to cocaine and combined with other drugs could cause adverse reactions.
> You asked about member's thoughts. I am thinking that you have a long conversation with whoever is prescribingg these drugs to you ans ask them the following:
> A. What is the probability of me to suddenly stop breathing, such as from my heart stopping, from taking these chemicals into my nervous system?
> B. Will I have to take these drugs for life unless I want to go through withdrawal from them?
> C. What evidence could you give to me that I have a chemical imbalance and taking these drugs will correct this imbalance?
> D. Does this mean that my brain is deficiant in Cymbalta?
> E. Why is it illegal in Ireland for the drug makers to say in the package insert to these drugs that there is a chemical imbalance that the drug will be used for?
> F. If these drugs are addictive, why are they legal to sell when, let's say, cocaine as an example, is not?
> G. If around 36,000 people die per year in the U.S. alone from related psychotropic drug issues, which means that world-wide it is likely that 300,000 die each year which could mean that millions of people could die from related issues with these drugs in the decades ahead, and that millions have died already from issues related from these drugs, how could these chemicals, in your opinion, be allowed to be sold?
> E. Will the drug company provide me with compensation from any pain/suffering if I have to go thriough a withdrawal period?
> F. If I die suddenly from these drugs that you prescribe to me, will you compensate my survivors for the grief that they could experiance and for the loss of me from them?
> LouFM,
Now if you have such a discussion with the person that is prescribing these drugs to you, and you are going to follow the advice of a member here to include Concerta which is a preparation of methylphenidate which Ritalin is, then I ask that you show the following video to him/her.
If you could, then I ask that you ask the prescriber:
A. What is going to happen to me if I include Concerta to the drugs that I am taking now that you have prescribed for me?
Lou
http://www.youtube.com/watch?v=JgIOdoy-K98&feature=channel
Posted by SLS on April 14, 2010, at 15:47:04
In reply to Lou's response-anythoughts-more considerations, posted by Lou Pilder on April 14, 2010, at 15:30:08
> A. What is going to happen to me if I include Concerta to the drugs that I am taking now that you have prescribed for me?
Is there something about combining these drugs specifically that is contraindicated?
- Scott
Posted by Frustratedmama on April 14, 2010, at 17:56:52
In reply to Cymbalta- dose related fatigue? or adjunct meds? » Lou Pilder, posted by SLS on April 14, 2010, at 15:47:04
Scott,,
How do you think concerta compares to Adderall XR? Currently taking 15 mg Adderall XRLou,
Thanks for your responses and I know that you are just looking out for members. I have tried going without meds before and became very volatile, and wouldn't want that part of my personality to return ever again. I know everyone responds differently to medication but I am one of the many that would be WORSE without them...I have gone off them many times. Tried meditation, prayer, alternative meds, natural supplements, etc. Had tests run, been poked, prodded, had MRI's etc. However, the use of the snri's has proven to be the most helpful.I dont like the side effects, but the benefits far outweigh the risks for me personally.
FM
Posted by SLS on April 14, 2010, at 18:22:53
In reply to For Lou and Scott » SLS, posted by Frustratedmama on April 14, 2010, at 17:56:52
> Scott,,
> How do you think concerta compares to Adderall XR? Currently taking 15 mg Adderall XRMethylphenidate (Concerta) is predominantly a catecholamine (NE, DA) reuptake inhibitor whereas amphetamine is more of a releaser. I don't know if one can predict in advance which of the two drugs will provide the most benefit against fatigue. Methylphenidate has been used successfully to treat various types of fatigue states including those evident in cancer and chronic fatigue syndrome. Personally, I found amphetamine (Dexedrine) to be "smoother" than methylphenidate (Ritalin). I thought methylphenidate produced some irritability. That's just me, though.
- Scott
Posted by Frustratedmama on April 14, 2010, at 19:49:38
In reply to Re: For Lou and Scott » Frustratedmama, posted by SLS on April 14, 2010, at 18:22:53
Thanks Scott,
I think I will bring this up tomorrow at my appt. I have been on adderall for a long time so a change might work well for a while :)
FM
Posted by Hombre on April 14, 2010, at 23:58:01
In reply to Re: Scott » SLS, posted by Frustratedmama on April 14, 2010, at 19:49:38
Frustratedmama,
You mentioned that your sleep is not so good.
*Do you have trouble falling asleep?
*How long can you stay asleep before you wake up?
*How often do you wake up?
*How many hours of good quality sleep do you think you are getting?
I'm struggling with sleep right now and my doctor and I are carefully trying to separate the sleep issue from the mood and energy issues. Not that they aren't related, and the medications are surely a part of the whole package, but lack of quality sleep sets up its own negative feedback loop of stress and fatigue that should not be ignored.
Hope you can work things out soon.
Posted by Lou Pilder on April 15, 2010, at 7:13:49
In reply to For Lou and Scott » SLS, posted by Frustratedmama on April 14, 2010, at 17:56:52
> Scott,,
> How do you think concerta compares to Adderall XR? Currently taking 15 mg Adderall XR
>
> Lou,
> Thanks for your responses and I know that you are just looking out for members. I have tried going without meds before and became very volatile, and wouldn't want that part of my personality to return ever again. I know everyone responds differently to medication but I am one of the many that would be WORSE without them...I have gone off them many times. Tried meditation, prayer, alternative meds, natural supplements, etc. Had tests run, been poked, prodded, had MRI's etc. However, the use of the snri's has proven to be the most helpful.
>
> I dont like the side effects, but the benefits far outweigh the risks for me personally.
>
> FMFM,
You wrote,[...Thanks for your responses...going without meds before and became very volatile...I am one of the many that would be worse without them...Tried ..prayer...I don't like the effects from the drugs (side)...benefits outway the risks...].
There is the condition that one can find themselves in when they stop a drug. This condition is sometimes said to be whatever it was before the drugs comming back. But it could also be withdrawal symptoms from the drug(s) the person was taking and then if the drug(s) is/are reinstated, the symptoms of withdrawal go away.
The question becomes to the user as to which one it is. There is a test for such.
In that condition, if the user stsys off the drug for a longer period, then it could be determined as to if the condition they find themselves in could or could not be withdrawal symptoms. Since the withdrawal symptoms could be so intolerable, the user could reinstate the drug(s) to stop those withdrawal conditions sooner than the time needed to determine if those symptoms were from the drugs. Then the addiction could be even more strenghthened to the user and withdrawal could be worse if they tried to do so in the future. If the prescriber of the drug (redacted by respondent).
This condition then can be exacerbated by the user getting another drug to take with the one that they stopped. Now there could be a compounding of the withdrawal if the user does so later from the combination of the drugs. This can continue untill maybe a lethal combination is taken and the user dies from the drugs or commits suicide. So a {side effect} in that case is that the user's mind could become altered to the point that they think that they must kill themselves. There is now an FDA warning to many psychotropic drugs that one taking them could have their mind altered to think of killing themselves. If the user finds themselves in that situation, I do not know how they could stop the suicide.
Then there is the placebo effect that research now shows is (redacted by respondent).
You write here that you tried prayer. I am unsure as to if your prayers were to a god and if so, which god? If it was to the god that is represented in the bible that Jews use, do you know what that bible says concerning the use of mind-altering drugs?
Lou
Posted by Dr. Bob on April 15, 2010, at 14:48:28
In reply to Lou's reply-wchgd? » Frustratedmama, posted by Lou Pilder on April 15, 2010, at 7:13:49
> You write here that you tried prayer. I am unsure as to if your prayers were to a god and if so, which god?
As Scott, said, that's a great topic, and is addressed on the Faith board. Here's a link:
http://www.dr-bob.org/babble/faith/20100403/msgs/943470.html
That'll be considered a new thread, so if you'd like to be notified by email of follow-ups to it, you'll need to request that there. Thanks,
Bob
Posted by Frustratedmama on April 16, 2010, at 9:14:20
In reply to Re: Scott, posted by Hombre on April 14, 2010, at 23:58:01
yeah, sleep is an issue....tried a lot of sleep meds...I can fall asleep ok...its staying asleep thats hard- meds that help me stay asleep cause more fatigue the next day- vicious cycle
Posted by SLS on April 16, 2010, at 9:36:20
In reply to Re: Scott » Hombre, posted by Frustratedmama on April 16, 2010, at 9:14:20
> yeah, sleep is an issue....tried a lot of sleep meds...I can fall asleep ok...its staying asleep thats hard- meds that help me stay asleep cause more fatigue the next day- vicious cycle
>Have you tried temazepam (Restoril)? It is more effective for sleep maintenance than it is for sleep induction/initiation.
- Scott
Posted by Hombre on April 21, 2010, at 5:16:41
In reply to Cymbalta- dose related fatigue? or adjunct meds?, posted by Frustratedmama on April 12, 2010, at 14:48:27
I really don't know what to suggest. I take Remeron and Seroquel to augment my AD (Effexor) and help with anxiety, agitation, anger and sleep issues. I find that at certain doses benzodiazapens or zopiclone (like lunesta) can cause too much sedation and a little depression the next day. Some supplements are also no good with this cocktail.
What I mean is that all the meds interact with each other in different ways depending on dosage. They may have unpredictable synergistic effects when altering the dosage of any of the meds. That could be good news - optimize dosage of your core meds. Perhaps higher dosages of certain meds could reduce the total amount of meds you have to take.
I hope that helps. It could just be confusing and unhelpful in which case I at least want to send you good juju and hope you feel better.
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.