Jump to content
CrazyBoards.org

Recommended Posts

Hi 

 

Sorry to post so much of late 

 

Apparently AD tweaks need to happen, in light of OCD Dx

 

Until Wednesday, I was on 180mg duloxetine. New pdoc said former pdoc's documentation lacked. But he said the only reason to rx above 120mg was intrusive thoughts. But former pdoc didn't explain the rise

 

He says target for duloxetine is 120. Currently down to 150, and today I think mood has slumped a bit

 

The add on. Which if I understand is adding not replacing is to be 1 of mirtazapine, sertraline, or escitalopram

 

Pdoc wants to monitor each change. So is monitoring the duloxetine decrease and addition of melatonin, before starting one 

 

From what I gather. If melatonin doesn't have me doing a Cinderella and turning into a pumpkin at midnight every night. He will push the mirtazapine

 

But I am wondering if anyone has experience with these three for mostly obsessive OCD? How you found them in terms of efficiency and side effects?

 

Or in general for GAD etc 

Link to comment
Share on other sites

I use sertraline for intrusive thoughts mostly, but I certainly obsess over them - not sure if that helps or not, in terms of compared to your symptoms.  But it's been a miracle drug. 

I barely have intrusive thoughts any more, and when I do, it's more detached - like the stuff about killing Toby, I'm not so agitated/worried I need to prepare now (I have thoughts about doing it 25, 30 years from now) - it's more, okay, well I can worry about it then, and I feel peace about it now.  (I finally told pdoc I still think about it, he said it's something to address but he knows I'm not homicidal...Toby knows too and seems unbothered, but if it were me, that'd freak me out a bit.

I don't know if that helps or not, but I would say in my experience of my OCD stuff sertraline has been amazing.

  • Like 1
Link to comment
Share on other sites

5 minutes ago, jarn said:

I use sertraline for intrusive thoughts mostly, but I certainly obsess over them - not sure if that helps or not, in terms of compared to your symptoms.  But it's been a miracle drug. 

I barely have intrusive thoughts any more, and when I do, it's more detached - like the stuff about killing Toby, I'm not so agitated/worried I need to prepare now (I have thoughts about doing it 25, 30 years from now) - it's more, okay, well I can worry about it then, and I feel peace about it now.  (I finally told pdoc I still think about it, he said it's something to address but he knows I'm not homicidal...Toby knows too and seems unbothered, but if it were me, that'd freak me out a bit.

I don't know if that helps or not, but I would say in my experience of my OCD stuff sertraline has been amazing.

thanks, jarn

 

i'm getting my head around terminology. But yes, intrusive thoughts are the big thing

 

interesting, the idea of detached intrusive thoughts

  • Like 1
Link to comment
Share on other sites

I don't know if you/other people get it like this, but with psychosis, once I have a specific delusion, the chance is pretty much 100% it will reoccur at some point.  Pdoc said the killing Toby thing was a little psychosis, a little intrusive, so perhaps that was a bad example.  But I don't have intrusive thoughts in general anymore.  

  • Like 1
Link to comment
Share on other sites

On 4/1/2022 at 8:18 AM, DogMan said:

Until Wednesday, I was on 180mg duloxetine. New pdoc said former pdoc's documentation lacked. But he said the only reason to rx above 120mg was intrusive thoughts. But former pdoc didn't explain the rise

Your pdoc does have a point. Generally speaking with duloxetine, 60mg is the target with a max of 120mg. You CAN go to 180mg, but statistically there isn't as much additional effect above 60mg to warrant the additional side effects, let alone 120mg.

However, that isn't to say it doesn't work for some people. Just because there wasn't additional effect above 60mg STATISTICALLY, it has clearly worked well for you for some time. So for every statistic, there are those who go against the statistic.

On 4/1/2022 at 8:18 AM, DogMan said:

He says target for duloxetine is 120. Currently down to 150, and today I think mood has slumped a bit

As long as your pdoc will allow it, go as slow as you need to. Duloxetine has a short-ish half-life. So decreases, particularly from high doses could really be a struggle.

On 4/1/2022 at 8:18 AM, DogMan said:

The add on. Which if I understand is adding not replacing is to be 1 of mirtazapine, sertraline, or escitalopram

Now this is curious. You're currently taking 1500mg sodium valproate, 4mg risperidone, 150mg duloxetine, 2mg melatonin. Adding mirtazapine to this cocktail makes sense. On its own it isn't the greatest antidepressant in the world, but for a lot of people it can do magical things when it's paired with just about any antidepressant, but particularly SNRIs like duloxetine. It has good sedative effects which make it good for sleep and anxiety, but paired with an SNRI it can actually be quite energizing during the day at higher doses.

Particularly if you're having trouble with sleep, it makes sense to try melatonin first to see if it helps, but success can be pretty low. So swapping the melatonin for mirtazapine will have you out like a light with as little as 7.5mg. However, 15mg and 30mg are good doses to augment an antidepressant. My personal experience with was with valproate+mirtazapine+bupropion. Something about the mirtazapine/bupropion combo didn't agree with me, but it did work. Never got to try it with other antidepressants.

Now adding sertraline or escitalopram to your existing cocktail would be a tad strange. It would make sense to replace duloxetine with either of these altogether, but it wouldn't make a whole lot of sense to take duloxetine WITH one of these. Antidepressants generally don't stack very well unless you have treatment resistant panic or OCD which often requires really high levels of serotonin transporter occupancy.

On 4/1/2022 at 8:18 AM, DogMan said:

Pdoc wants to monitor each change. So is monitoring the duloxetine decrease and addition of melatonin, before starting one 

Yeah better to do one thing at a time. And also better to try the melatonin before proceeding to mirtazapine. Don't get me wrong, mirtazapine is a unique gem, but it's not for everyone. Some people experience too much sedation and some weight gain, which is often why people stop taking it.

On 4/1/2022 at 8:18 AM, DogMan said:

From what I gather. If melatonin doesn't have me doing a Cinderella and turning into a pumpkin at midnight every night. He will push the mirtazapine

Again, makes sense. Try something a bit more "natural" before proceeding to a hammer.

On 4/1/2022 at 8:18 AM, DogMan said:

But I am wondering if anyone has experience with these three for mostly obsessive OCD? How you found them in terms of efficiency and side effects?

Or in general for GAD etc 

I can say that my anxiety was very under control when I took mirtazapine. There are a few things mirtazapine is good for: insomnia, anxiety, no appetite. It will have you sleeping, relaxed, and hungry. However, like I said, mirtazapine has more of these sedative effects at doses up to 15mg. However, once you get to 30mg and 45mg, mirtazapine acts more as an antidepressant, and paired with duloxetine, you may find you are quite stimulated during the day.

Kind of as a side note, you mentioned that your mood has dipped since decreasing the duloxetine. Mirtazapine may be a good way to replace some of what you'll lose by decreasing the duloxetine to 120mg. Even 15mg mirtazapine might be enough.

  • Thanks 1
Link to comment
Share on other sites

42 minutes ago, echolocation said:

i took sertraline for GAD before i knew i had OCD (well, i had a suspicion) and for me it revved me up a bit and made my intrusive thoughts worse. i remember having just such a busy brain.

that is interesting. Thanks

Link to comment
Share on other sites

On 4/2/2022 at 2:21 PM, browri said:

Now adding sertraline or escitalopram to your existing cocktail would be a tad strange

This was my thought too. I actually have a good friend that uses low-ish dose of cymbalta plus low ish dose of escitalopram, but that’s only because she needs the cymbalta to treat migraines. Personally I think I’d shoot for the remeron. Unless one of your symptoms/current side effects is bad sedation in which case that might be problematic 

Link to comment
Share on other sites

7 hours ago, Iceberg said:

but that’s only because she needs the cymbalta to treat migraines

Interesting. That'll be the first time I've heard of Cymbalta being used for migraines, but I suppose there's a first for everything. The idea behind some of the -triptan anti-migraine medication was that they activated 5HT1B/1D receptors, which results in a reduction of calcitonin, believed to be a migraine biomarker. Theoretically any medication which increases activation of these receptors, including antidepressants like duloxetine, should be able to do the same thing. Amitriptyline is used for this purpose. Duloxetine has benefit in neuropathic pain via norepinephrine stimulation in the brain stem. Maybe it has benefit in pain like trigeminal neuralgia? 🤷‍♂️

Still, if the issue being treated is depression/anxiety/panic/OCD and you're using reuptake inhibitors, it's less complicated to use one serotonin reuptake inhibitor than two. Stacking escitalopam with bupropion makes sense (two different modes of action that enhance each other). stacking mirtazapine with fluoxetine, duloxetine, or venlafaxine (again unique but complementary mechanisms of action) makes sense. But stacking two medications of the same mechanism of action is complicated. It may work for some people, but the complexity it adds to a cocktail may not be worth it.

Link to comment
Share on other sites

29 minutes ago, browri said:

two. Stacking escitalopam with bupropion makes sense (two different modes of action that enhance each other). stacking mirtazapine with fluoxetine, duloxetine, or venlafaxine (again unique but complementary mechanisms of action) makes sense. But stacking two medications of the same mechanism of action is complicated

Also I would think if the one action isn’t effective, targeting something else in addition might increase chance of success 

 

29 minutes ago, browri said:

Interesting. That'll be the first time I've heard of Cymbalta being used for migraines

She is the same level of painstakingly refractory for migraines that many of us on here are for psych meds (which we share much dark humor about) so basically if anything hints at improvement they stick with it 

  • Like 1
Link to comment
Share on other sites

  • 4 weeks later...

Down to 120mg since Friday, and fucking dying 

 

Next Tuesday I see Dr who will explain the plan better 

 

She said on the phone that pdoc wants me on mirtazapine because he thinks that I will sleep better 

 

I think new case manager understands that heavy side effects will lead to forcing wakefulness for 36 hours to avoid taking nighty meds 

 

So hopefully she advocates to that end on Tuesday 

 

If I live that long. If the intrusions don't kill me, the nausea might 

 

Fuck 

Link to comment
Share on other sites

15 minutes ago, dancesintherain said:

Do you have a GP who could prescribe you something for nausea just as a temporary fix?

do have a gp

 

but not one that likes medicine

 

he'd just call me fat, and tell me to take up jogging

Link to comment
Share on other sites

  • 2 weeks later...

pharmacist recommended eno for nausea https://www.woolworths.com.au/shop/productdetails/44307/eno-salts-fruit-lemon

 

it helps some

 

does anybody know the cross taper process from duloxetine (cymbalta) to sertraline (don't know, i think zoloft)

 

have weaned from 180mg to 90

 

180 > 150 was 4 weeks

150 > 120 2 weeks

now 90 for 2 weeks

"then the rest, over a month or two"

 

hoping that i can start sertraline before completely stopping

 

suffering on many levels

 

if a pdoc ever suggests suprathreshold SNRI, slap him. This is fucked

Link to comment
Share on other sites

oof, that does sound like it would be painful. 

I'm afraid I don't know the titration schedule.  My pdoc is usually a bit more aggressive on those things than most, so to be honest even if I had gone through things, it probably wouldn't be a good gauge.  Might not hurt to mention that you want to start the sertraline before getting completely off?

  • Like 1
Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...