new pdoc wants to do a major med switch

[hollywoodfreaks]

I saw my new pdoc today for the first time, and he seems to have a rather aggressive approach to treatment.

He suggested that since my mood cycles down into depression fairly frequently (although it cycles back up again in a few days), my depression is not being controlled well enough with Lexapro. I also just started 300mg of Wellbutrin, but he didn't seem to want to wait that one out because I've taken that before. Instead, he wants me to start Cymbalta and taper off the Lexapro at the same time (a rather fast taper, too, I might add--Cymbalta 30 mg for the first week, keeping the rest the same, then 60mg Cymbalta and 10mg Lexapro the second, then no Lexapro the third. Does that seem like a reasonable schedule?). So my new combo would be Cymbalta and Wellbutrin. He said if this didn't work, or I continued to cycle, that we should consider starting Lamitcal. I'm like damn, way to cut to the chase, dude!

Anyway, I just am not sure that this is justified, because I'm only depressed some of the time (maybe even a minority of the time--I'm not sure). I thought it was a little weird that he didn't want to wait and see what the Wellbutrin did first. I have never done a wholesale med switch before either. I wanted to check and see how risky this med plan seems in terms of withdrawal effects, chance of too much serotonin, whatever.

[Penny Century]

did you ask him about the aggressive nature of the changes and why he wanted them done so quickly?

is he the kind of doctor who is easily reachable if something goes awry? i had one pdoc who made me come in weekly when we did a major med switch, which was very reassuring, but i think insurance rules make that financially unfeasible often depending on the insurance.

i don't know about the seratonin syndrome. but i do think it's important that you communicate openly with him that you are concerned about how radical the changes are to your meds.

lexapro generally doesn't have major withdrawal issues, and people usually have less withdrawal issues when they taper up on another seratonin med while tapering off their old med. you may have side effects from starting the cymbalta, of course.

cymbalta and wellbutrin is a strong combo that does work for a lot of people. but if you are uncomfortable with the pace and worried your doctor needs to know.

[hollywoodfreaks]

No, I'm fine with it I guess, I did express my concerns to him at the appointment and he explained his rationale. It just now that it's time to start it, it's a little scary. I just wanted to check and see if my tapering schedule is unusual or anything. I've never tried switching meds before like this. My only other concerns are side effects (especially the whole liver thing) and the withdrawals. I already read the PI sheet and I can look up more info.

Oh yeah, the thing that definitely *does* bother me--I told him I was sick of the sexual side effects of Lexapro and that I basically had no libido, but somehow I doubt that Cymbalta is going to be much different if I was so badly affected by Lexapro. That *does* kind of piss me off. I'm married dude! My husband is going to get really sick of no sex eventually.

[Catnapper]

I don't think the switch is being done too quickly, but I'm not a pdoc, either. Also, unless you have other related health problems like hepatitis or cirrohsis (sp?) I don't think you have anything to worry about with your liver.

One thing I've found very helpful when switching drugs is to keep a very simple mood chart, where I just put a single check mark every day related to my mood based on a scale of one to ten. One represents suicidal and ten represents the look on Venus Williams' face the last time she won Wimbledon, or sheer joy, in other words.

I made a very simple spreadsheet that I could print out or e-mail to the doc and it clearly showed when drugs were working or not, although you could also just write that day's rating number on a calendar. However you do it, it gives a clear picture of your mood over time, especially since it's hard to remember how you felt on any given day a couple of weeks later.

Hope the new drugs work for you.

[Velvet Elvis]

Cymbalta comes into effect fairly quickly so That doesn't sound unreasonable to me.

Wellbutrin + Cymbalta has been a good combo for me in the past though I ditched the wellbutrin side of it recently.

[hollywoodfreaks]

Thanks for the reassurance guys. I'll just give it a shot and see what happens. I probably am going to get the occasional liver test though, just for my own peace of mind, since I know WB and Cymbalta both work the liver hard.