![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 8 to 32 of 38. Go back in thread:
Posted by Laney on October 30, 2011, at 18:38:31
In reply to Re: Savella update » Phillipa, posted by gadchik on October 30, 2011, at 18:31:59
Gadchik,
I have never had to raise the dose on K which has been a good thing. Maybe on occasion but never on a regular basis. No blood tests. I have been on it for about 18 years. Was on Xanax first but it's too short acting. I didn't like it when it wore off and I needed to dose again. This way I take one k per day and it's in the am.
Laney
Posted by Laney on October 30, 2011, at 18:43:01
In reply to Re: Savella update, posted by jono_in_adelaide on October 30, 2011, at 18:20:14
Jono,
Hard to say what the therapeutic dose will be. It's mainly been used for fibro. It seems like for those that it has worked, they started low and went up slow. I will probably move up to 18.75 in a couple of days. But like I said, I'll have to see how the SE are in comparison to improvements (hopefully).
Laney
Posted by floatingbridge on October 30, 2011, at 19:05:30
In reply to Re: Savella update » jono_in_adelaide, posted by Laney on October 30, 2011, at 18:43:01
Laney, good luck with this one.
Posted by bleauberry on October 31, 2011, at 4:59:57
In reply to Savella update, posted by Laney on October 30, 2011, at 16:33:48
That sounds good. A little bit more than I could tolerate at the start. But looks good. The NE stuff takes longer to adjust I think than serotonin stuff does. Maybe because NE is intertwined with adrenal and pituitary, dunno. Some of the clinical trial people said the main benefits took months to gradually show up, almost as if body biochemistries were slowly being repaired and reset. Same with side effects, it took a while.
Anyway, I think the biggest cause of failure with savella is caused by too high of a dose or getting to a high dose too fast. So in my opinion you seem to be approaching this the right way.
Posted by Christ_empowered on October 31, 2011, at 8:23:58
In reply to Re: Savella update, posted by bleauberry on October 31, 2011, at 4:59:57
I really hope this works out for you. Start low, go slow is (almost) always a good idea, unless you're in some kind of psychiatric emergency. What symptom(s) are you targeting?
Posted by Laney on October 31, 2011, at 20:32:20
In reply to Re: Savella update, posted by Christ_empowered on October 31, 2011, at 8:23:58
CE,
I'm targeting mainly irritable depression with ruminating negative thoughts. It all started after trying to get off of paxil a few years back and going through the hell of that withdrawl and never getting myself back afterwards. Nortriptyline came the closest but it came with 22 lbs. of weight gain over 9 months.
Laney
Posted by SLS on October 31, 2011, at 23:14:25
In reply to Re: Savella update, posted by Laney on October 31, 2011, at 20:32:20
> CE,
>
> I'm targeting mainly irritable depression with ruminating negative thoughts. It all started after trying to get off of paxil a few years back and going through the hell of that withdrawl and never getting myself back afterwards. Nortriptyline came the closest but it came with 22 lbs. of weight gain over 9 months.
>
> Laney
I may have mentioned this already, but desipramine often works for people who are TCA responders, but is usually without weight-gain.
- Scott
Posted by Laney on October 31, 2011, at 23:35:19
In reply to Re: Savella update » Laney, posted by SLS on October 31, 2011, at 23:14:25
Scott,
You have but it doesn't do it for me. Tried it twice. It's a no go. But thanks for thinking!
Laney
Posted by SLS on November 1, 2011, at 5:57:58
In reply to Re: Savella update » SLS, posted by Laney on October 31, 2011, at 23:35:19
> Scott,
>
> You have but it doesn't do it for me. Tried it twice. It's a no go. But thanks for thinking!
>
> Laney
I'm trying!You ask such good questions, but many of them have no answers that I can come up with. Keep trying. I hope Savella works for you. It would make things so much easier.
At this juncture, I would like to mention that several people I know of have responded well to Pristiq whom didn't respond well to Effexor. However, the reverse is probably also true. If you don't respond well to Savella, I would not rule-out another SNRI.
- Scott
Posted by floatingbridge on November 1, 2011, at 9:08:22
In reply to Re: Savella update » Laney, posted by SLS on November 1, 2011, at 5:57:58
Laney, have you tried Pristiq? It is gentler regarding sx profile. None of the jaw tension etc for most folks.
That's a very good idea, Scott.
Posted by Laney on November 1, 2011, at 18:58:54
In reply to Re: Savella update » SLS, posted by floatingbridge on November 1, 2011, at 9:08:22
Well the jaw/neck/head thing resolved today so I will increase my dosage.
How long do you think it ought to take before I notice something?
Just curious. I can't even remember how long it took for Nort. to work but it wasn't long.
Again - thanks!
Laney
Posted by SLS on November 1, 2011, at 19:40:34
In reply to Re: Savella update, posted by Laney on November 1, 2011, at 18:58:54
Hi Laney.> Well the jaw/neck/head thing resolved today so I will increase my dosage.
That's good.
> How long do you think it ought to take before I notice something?I have not heard of anything that would lead me to believe that Savella takes longer to work than most other antidepressants. Maybe Bleauberry has some insight into this. Otherwise, you might see some benefit by week 3 if the dosage is right for you. One is encouraged to allow at least 6 weeks to pass before declaring the trial to be a failure.
- Scott
Posted by SLS on November 1, 2011, at 20:00:38
In reply to Re: Savella update » Laney, posted by SLS on November 1, 2011, at 19:40:34
>
> Hi Laney.
>
> > Well the jaw/neck/head thing resolved today so I will increase my dosage.
>
> That's good.
>
> > How long do you think it ought to take before I notice something?
>
> I have not heard of anything that would lead me to believe that Savella takes longer to work than most other antidepressants. Maybe Bleauberry has some insight into this. Otherwise, you might see some benefit by week 3 if the dosage is right for you. One is encouraged to allow at least 6 weeks to pass before declaring the trial to be a failure.Harvard/Mass General did a nice study a few years ago to evaluate the probability of responding to treatment over the length of a drug trial. They found that relatively few of those people who had not improved by four weeks went on to respond by six weeks. I would still wait, though, especially if you are treatment resistant.
- Scott
Posted by Phillipa on November 1, 2011, at 21:19:08
In reply to Re: Savella update, posted by Laney on November 1, 2011, at 18:58:54
Laney that's great news. Congrats. Phillipa
Posted by Laney on November 3, 2011, at 12:44:28
In reply to Re: Savella update » Laney, posted by Phillipa on November 1, 2011, at 21:19:08
Thanks Scott. It's only been a week. I just want it to work as quckly as Nort. did for me but that was probably not the norm.
I'll keep you updated!
Laney
Posted by SLS on November 9, 2011, at 10:57:34
In reply to Re: Savella update, posted by Laney on November 3, 2011, at 12:44:28
> Thanks Scott. It's only been a week. I just want it to work as quckly as Nort. did for me but that was probably not the norm.
>
> I'll keep you updated!
>
> Laney
I hope these last few days have been better for you, and that you are beginning to respond to Savella.I look forward to seeing your update.
- Scott
Posted by Laney on November 17, 2011, at 0:04:35
In reply to Re: Savella update » Laney, posted by SLS on November 9, 2011, at 10:57:34
Hi guys!
So Friday will be three weeks on Savella. I finally experienced some improvement in mood by day 10 or so and thought that I was on the mend but the last couple of days, I have gone backwards. I will be going to 75mg. tomorrow. I know I have a lot of room to increase the dose so we'll see. I'm hanging in there and giving this a fair trial.
I will get back to you shortly.
Laney
Posted by SLS on November 17, 2011, at 6:53:26
In reply to Re: Savella update, posted by Laney on November 17, 2011, at 0:04:35
> Hi guys!
>
> So Friday will be three weeks on Savella. I finally experienced some improvement in mood by day 10 or so and thought that I was on the mend but the last couple of days, I have gone backwards. I will be going to 75mg. tomorrow. I know I have a lot of room to increase the dose so we'll see. I'm hanging in there and giving this a fair trial.
>
> I will get back to you shortly.Thanks for the update.
I'm glad that you are being patient and taking things logically step by step. I went up to 150 mg.
- Scott-------------------------------------------
http://www.ncbi.nlm.nih.gov/pubmed/15486520Int Clin Psychopharmacol. 2004 Nov;19(6):343-6.
Controlled comparison of two different doses of milnacipran in major depressive outpatients.
Kanemoto K, Matsubara M, Yamashita K, Tarao Y, Inada E, Sekine T.
SourceDepartment of Neuropsychiatry, Aichi Medical University, Aichi, Japan. peh06237@nifty.ne.jp
AbstractWe compared the antidepressant efficacy and patient tolerance of two different doses of milnacipran (75 mg and 150 mg daily) in 66 outpatients with major depression, using the 17-item Hamilton Depression Rating Scale (HDRS). Only new patients who had never experienced frank depressive episodes before, or those who had remained free from thymoregulators for more than 1 year without recurrence of depressive symptoms, were recruited. Subjects were randomly selected to receive a daily dose of milnacipran that reached either 75 mg or 150 mg within 2-3 weeks and then remained stable over an 8-week period. The results showed a significant superiority of milnacipran at 150 mg/day over 75 mg/day at the end of the study period in both response (50% or more decrease in total score from baseline, P=0.026) and remission (total HDRS score lower than 7 points, P=0.034). A response was recorded for 56.0% of the patients treated with 75 mg of milnacipran and for 84.6% of those treated with 150 mg after the 8-week study period. No significant difference was seen between the treatment groups for either individual or total incidence of adverse events. Notably, nausea and vomiting occurred most often immediately after the first visit, when subjects in both groups started with a daily dose of 50 mg. We conclude that additional comparisons between different doses of milnacipran should be performed to confirm or deny the linear dose/efficacy relationship observed in the present study.
Posted by Laney on November 17, 2011, at 21:27:51
In reply to Re: Savella update, posted by SLS on November 17, 2011, at 6:53:26
My pdoc said the target dose should be 100mg per day?
What you think?
Laney
Posted by floatingbridge on November 17, 2011, at 21:58:44
In reply to Re: Savella update, posted by Laney on November 17, 2011, at 0:04:35
Good luck Laney. I'm glad you have seen some improvement despite the slight backwards dip. Keep at it.
Posted by SLS on November 17, 2011, at 22:53:04
In reply to Re: Savella update, posted by Laney on November 17, 2011, at 21:27:51
> My pdoc said the target dose should be 100mg per day?
>
> What you think?
>
> Laney
I think 100 mg should do it.
- Scott
Posted by Laney on November 23, 2011, at 11:33:23
In reply to Re: Savella update » Laney, posted by SLS on November 17, 2011, at 22:53:04
Friday will be 4 weeks and nothing newsworthy to report. Probably just more sleepy and blah feeling more than anything. I really don't expect that it's going to do it for me.
Scott, I was thinking of giving it 5 weeks. What do you think?
So I'm also looking forward. What next? Cymbalta, Effexor?? Any ideas?
Thanks!
Laney
Posted by Laney on November 23, 2011, at 11:35:08
In reply to Re: Savella update, posted by Laney on November 23, 2011, at 11:33:23
Does this sound crazy? Just adding a stimulant like adderall or ritalin or that class of drugs? Maybe that's all I need.
Thanks!
Posted by SLS on November 23, 2011, at 12:19:16
In reply to Re: Savella update, posted by Laney on November 23, 2011, at 11:33:23
> Friday will be 4 weeks and nothing newsworthy to report. Probably just more sleepy and blah feeling more than anything. I really don't expect that it's going to do it for me.
>
> Scott, I was thinking of giving it 5 weeks. What do you think?Are you taking 100 mg? I should think that you would have felt something by four weeks at that dosage. It is hard to say, though. You know that. You could try going up to 150 mg for two or three weeks just to be sure.
http://www.medscape.com/viewarticle/528303_4
> So I'm also looking forward. What next? Cymbalta, Effexor?? Any ideas?
Have you had positive results from any medication? If so, which ones?
I don't think Savella will get as many people well as Effexor or Cymbalta. Not all SNRIs are alike. Again, I'm sure you understand this. Meridia, an antiobesity drug (no longer available), has little or no antidepressant properties.
A stimulant might help boost a weak response to an antidepressant drug, but I am not convinced that it would make any difference if there is no response at all. I wish that I could be certain of this, but I doubt you will find a scientific investigation addressing this question.
- Scott
Posted by Laney on November 23, 2011, at 12:32:11
In reply to Re: Savella update » Laney, posted by SLS on November 23, 2011, at 12:19:16
Scott,
I've only gotten response from Nortriptyline but with a lot of weight gain.
I would have to see if my doc would want to go up to 150. Doubtful.
So you don't think adding a stimulant would do it? I do have ADD or ADHD features if you ask me. Never been diagnosed although it seems obvious to me.
Laney
Go forward in 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.