Cymbalta

[Guest Spiderman]

Struggle with anxiety_a little depression_a little OCD. Doctor switched me just this week from Prozac to Cymbalta at 20mg for a week and then to 40 for a week and then t0 60 until the end ofr March. He says I can take some in the morning and some at night, dropped him a line but haven't heard back. What strengh capsules do you take it in and do you split it up between am and pm? what is the higher end approved dose for this medication? Does anyone know if it works on the serotonin first or the other stuff and how it is different then effexor? Anyone have luck with this for add type issue and anxiety? How about liver stuff, is that a simple blood test because I already get liver checks from lipitor for high cholesterol.

[Velvet Elvis]

I just take 60 at night.

It's approved for up 120mgs for pain but doses higher than 60 haven't been shown effective for depression. It's just recently been approved for anxiety but I don't know at what doses.

[Sunshine]

According to the official PI sheet, if being used to treat depression, initial dosage should be 40 mg/day (20 mg 2x/day) up to 60 mg/day (either once a day or 30 mg 2x/day). For generalized anxiety disorder, initial dosage is usually 60 mg 1x/day, but for some patients it may be desirable to start at 30 mg 1x/day for 1 week.

From personal experience (treating depression and mild anxiety), 30 mg for 1-2 weeks and then 60 mg did the trick. I understand the 20 mg capsules are hard to come by (though maybe that has since changed... when I was on it, it was fairly new).

As for liver problems, unless you've got them to begin with (in which case, Cymbalta might not be a good choice) or on other meds the hit the liver really hard, you shouldn't need to have enzymes tested - especially if you don't surpass the 60 mg mark. You should, however, limit your alcohol consumption.

[LikeMinded]

My old pdoc (in Indiana) had the advice of yearly liver panels. On Cymbalta, mine were never abnormal (though they did go wonky for no known reason about a year of starting therapy... though they've stayed at the exact semi-high wonky level for several months, so no need for concern...... yet).

Note that this same pdoc who was <20 miles from Lilly's headquarters in downtown Indianapolis. He's often harrassed by their drug reps regarding Cymbalta and Zyprexa.

Cymbalta does indeed have a warning on it regarding liver damage (though I personally question the US FDA in their rationale of doing... well, pretty much anything). All I can say is be careful.

[Guest spiderman]

good information so thanks to ya all. I am on 40 right now as of today. I am gonna start taking it at night tomorrow though. I think it makes me weird soft of tired but not tired during the day but tired enough to want to sleep for a while after work which then ruins my nights sleep. Hope that goes away cause it sucks. I want to feel better but not be tired all the time like on prozac or luvox. I also need something to help me get to sleep at night so maybe if I do a good nights rest then i wont be tired durinng the day.

My old pdoc (in Indiana) had the advice of yearly liver panels. On Cymbalta, mine were never abnormal (though they did go wonky for no known reason about a year of starting therapy... though they've stayed at the exact semi-high wonky level for several months, so no need for concern...... yet).

Note that this same pdoc who was <20 miles from Lilly's headquarters in downtown Indianapolis. He's often harrassed by their drug reps regarding Cymbalta and Zyprexa.

Cymbalta does indeed have a warning on it regarding liver damage (though I personally question the US FDA in their rationale of doing... well, pretty much anything). All I can say is be careful.

[Peaty]

Cymbalta works pretty well for my depression. Kept me from killing myself a year ago. It's not really working for my anxiety though. I have a lot of internalized anxiety and anxiety from external stimuli (sounds, people, smells). I think if I didn't have such a problem with external stimuli causing me so much distress the Cymbalta might cover the anxiety aspect too.

[Guest reply for sunshine]

Sunshine do you mind if I ask why you stop taking the cymbalta?

According to the official PI sheet, if being used to treat depression, initial dosage should be 40 mg/day (20 mg 2x/day) up to 60 mg/day (either once a day or 30 mg 2x/day). For generalized anxiety disorder, initial dosage is usually 60 mg 1x/day, but for some patients it may be desirable to start at 30 mg 1x/day for 1 week.

From personal experience (treating depression and mild anxiety), 30 mg for 1-2 weeks and then 60 mg did the trick. I understand the 20 mg capsules are hard to come by (though maybe that has since changed... when I was on it, it was fairly new).

As for liver problems, unless you've got them to begin with (in which case, Cymbalta might not be a good choice) or on other meds the hit the liver really hard, you shouldn't need to have enzymes tested - especially if you don't surpass the 60 mg mark. You should, however, limit your alcohol consumption.

[Libby]

i'm on 90 mg Cymbalta for depression and anxiety. It doesn't quite do the trick, so I'm also on Seroquel for same. I take Cymbalta in the morning... I didn't know people took it at night. Is night time recommended?

[Guest spiderman]

I am also wondering if it is recommended to take in the morning or at night? Does anyone know if they have some ADD symptoms if Cymbalta would help in theory? I did not get to talk to the doctor I see about that but some have mentioned i have some of the symptoms. although they all agree the biggest problems are anxiety_OCD_some_depression and possibly some add things. I wonder since stratterra fixes add because it works on one of the chemicals cymbalta does then wouldnt cymbalta do it also. What is dopamine for?

i'm on 90 mg Cymbalta for depression and anxiety. It doesn't quite do the trick, so I'm also on Seroquel for same. I take Cymbalta in the morning... I didn't know people took it at night. Is night time recommended?

[Velvet Elvis]

It's done nothing for my ADD I don't think but it has helped a lot with everything else. If you have a lot of indications, don't expect one pill to treat them all. That one pill doesn't exist. There is no psychiatric equivalent to NyQuill

I take it at night as it was making me kind sleeping when I took it during the day.

The halflife is long enough that it shouldn't matter when you take it in terms of effectiveness.

[Sunshine]

Sunshine do you mind if I ask why you stop taking the cymbalta?

I forgot to take it several days in a row (it was over the Christmas holiday a little over a year ago and my schedule was off). I was only on 30 mg at the time. I did notice some mild discontinuation symptoms, but still kept forgetting to take it. Then I figured since I'd done the discontinuation I'd see how I felt off it. My depression episodes tend to be considerably situationally aggravated and what triggered that bout was somewhat resolved. Since I didn't slide back into the pit of despair, I didn't go back on it. If another bout hits ever again, it will be the first med I tried (by the time I went on the Cymbalta, I'd tried close to a dozen different ADs in the two years prior).

I am also wondering if it is recommended to take in the morning or at night?

I always took the full dose in the morning. If I remember correctly, I don't think it matters. But one of the meds I was on, it did matter (slightly)... it's possible it was this one.

Does anyone know if they have some ADD symptoms if Cymbalta would help in theory? I did not get to talk to the doctor I see about that but some have mentioned i have some of the symptoms. although they all agree the biggest problems are anxiety_OCD_some_depression and possibly some add things. I wonder since stratterra fixes add because it works on one of the chemicals cymbalta does then wouldnt cymbalta do it also. What is dopamine for?

I was on Adderall the whole time I was on it, so I can't say for certain, but in theory I doubt it would be of much help - especially for inattentive type ADD. Studies are starting to show (and my pdoc firmly believes) that norepinephrine reuptake inhibitors don't do squat for ADD (including Strattera). Additionally, I'm pretty sure Cymbalta doesn't hit norepinephrine as hard as it does serotonin - especially at 60 mg. I might be wrong about this, though.

Dopamine is a neurotransmitter (as are serotonin and norepinephrine). It's responsible for many things, but in terms of mental illness, it's "central to the reward system. Dopamine neurons are activated when an unexpected reward is presented. In nature, we learn to repeat behaviors that lead to unexpected rewards. Dopamine is therefore believed by many to provide a teaching signal to parts of the brain responsible for acquiring new motor sequences, i.e., behaviors." (Courtesy Wikipedia).

Additionally (also courtesy of Wikipedia):

"In the frontal lobes, dopamine controls the flow of information from other areas of the brain. Dopamine disorders in this region of the brain can cause a decline in neurocognitive functions, especially memory, attention, and problem-solving. Reduced dopamine concentrations in the prefrontal cortex are thought to contribute to attention deficit disorder and some symptoms of schizophrenia."

And (edited to remove the really geeky stuff)...

"Dopamine is commonly associated with the pleasure system of the brain, providing feelings of enjoyment and reinforcement to motivate a person proactively to perform certain activities. Dopamine is released by naturally rewarding experiences such as food, sex, and use of certain drugs and neutral stimuli that become associated with them.

"Sociability is also closely tied to dopamine neurotransmission. Low D2 receptor binding is found in people with social anxiety. Traits common to negative schizophrenia (social withdrawal, apathy, anhedonia) are thought to be related to a hypodopaminergic state in certain areas of the brain. In instances of bipolar, manic subjects can become hypersocial as well as hypersexual. This is also credited to an increase in dopamine, because mania alleviates from dopamine blocking antipsychotics.

"Research suggests a crucial role of dopamine in reward systems and anticipation of pleasure. Dopamine may also have a role in the salience ('noticeableness') of perceived objects and events, with potentially important stimuli such as: 1) rewarding things or 2) dangerous or threatening things seeming more noticeable or important. This hypothesis argues that dopamine assists decision-making by influencing the priority, or level of desire, of such stimuli to the person concerned.

"Deficits in dopamine levels are implicated in Attention-deficit hyperactivity disorder(ADHD), and stimulant medications used to successfully treat the disorder increase dopamine neurotransmitter levels, leading to decreased symptoms."

Wellbutrin does some dopamine reuptake inhibition (secondary to norepinephrine reuptake inhibition - especially at lower doses). Amphetamines such as Adderall or Ritalin (if I understand this correctly) sort of increase the levels of dopamine. I say sort of because they don't actually increase dopamine levels... they are just structurally similar to dopamine.

It's been my experience that amphetamines can be powerful antidepressants (gee... when you read the above it's hard to not understand why!), but that norepinephrine reuptake inhibitors, while also effective (in combo with SSRIs) for depression and anxiety, don't do squat for ADD.

One other thing I'd like to point out is that ADD-like behavior is often a symptom of depression. My ADD symtoms are considerably worse when I'm depressed.