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Savella VS Cymbalta for Depression

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I have read that Savella (at least as of the time of the information I found) hasn't officially been approved for depression. I have fibromyalgia and my Cymbalta hasn't helped that. My neurologist rx'd Savella and I'm waiting to hear my pdoc's feedback on that change before I go through with it. I'm just curious if anyone who changed from Cymbalta to Savella-- or anyone who has been on Savella at all -- can tell me some experiences or whatever. I've seen very little about Savella on the couple boards I frequent.

And if anyone can explain the basic differences. My neurologist explained a little me, that the make up of one is heavier in Seritonin than the other (3 to 1 vs 10 to 1 or something of that sort). What difference would the make up cause? I'm afraid to mes with my depression. But this pain is so ridiculously bad.... I have to try something.

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Sorry, never taken Savella. I hope it works well for you though!

That's right about Savella having a 3:1 SRI:NRI ratio and Cymbalta having a 1:10 ratio. What this means is Savella is 3 times more potent in norepinephrine reuptake inhibition than it is in serotonin reuptake inhibition (and may in this way work somewhat like a tricyclic antidepressant, except without the miscellaneous receptor binding), whereas Cymbalta is 10 times more potent in serotonin reuptake inhibition than it is in norepinephrine reuptake inhibition. My guess would be that it would probably work a lot better for your fibromyalgia and maybe for your depression. The stronger NRI of Savella may enhance dopamine neurotransmission more than Cymbalta (because NRI causes increased dopamine transmission in the prefrontal cortex). It's not indicated for depression in the US, but it is in other countries, so don't be afraid that it might mess with your depression.

Give it a try, and in the event that it does mess with your depression, maybe you could try a TCA instead for fibromyalgia? Amitriptyline (Elavil) is apparently the most well-studied TCA for use in treating FM, and is also quite helpful for depression too, although nortriptyline (Pamelor) and imipramine (Tofranil) have been studied to a lesser extent.

Gabapentin (Neurontin, Gralise) is an anticonvulsant that may help with FM symptoms as well as mood disruptions (usually used for anxiety and mania though, though it may have a beneficial effect on depression).

The opioid, tramadol (ConZip, Rybix ODT, Ryzolt, Ultram/Ultram ER), is also used for FM, and may theoretically have beneficial effects for depression, as it is a serotonin reuptake inhibitor and releasing agent (have to watch out with combining it with SSRI's/SNRI's), a norepinephrine reuptake inhibitor, and a 5-HT2C antagonist (which disinhibits release of dopamine and norepinephrine release).

I got a little off topic, but I hope this at least somewhat answers your question about the differences. If you have any more questions about their differences, just ask. :)

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