Cymbalta

[kaflyboy]

I recently tapered off Effexor (37.5) to 0 and started latuda.  Latuda knocked me out, literally could not stay awake, so I'm off that and on 30 of cymbalta (generic).  

I feel relatively depressed, unmotivated, racing mind.  How long does cymbalta take to get in your system?   I've been on 30 for about a week   

im also on 450 of lamotorgine.  

Thanks in advance.  

[mikl_pls]

My pdoc has said to me that Cymbalta takes a little longer to work for depression for some people. Can't say exactly for sure how long it will take to work for you personally, but the fact that you have been on an antidepressant already helps since your receptors are already downregulated to some extent or another.

Any idea how long you'll be on 30 mg? 60 mg is the target dose. Was your pdoc concerned about you being able to tolerate it or something?

Personally, for me, Cymbalta took about a week or so to work, but as everyone says here, YMMV.

[kaflyboy]

Thanks for the reply.   Based on some of your other posts, it looks like you know your stuff.

i've been on the cymbalta for about a week and it's starting to "kick in" a little.   being off effexor onto Latuda (which sucked) was a ride.   

I was on the 37.5 of effexor and i guess my p-doc just doesn't want me to get all "dosed up" on cymbalta.

in your experience, what is the difference between effexor and cymbalta?   i was on effexor for 10 +/- years.   i'm also on Lamotrigine (450).   

[mikl_pls]

10 minutes ago, kaflyboy said:

Thanks for the reply.   Based on some of your other posts, it looks like you know your stuff.

i've been on the cymbalta for about a week and it's starting to "kick in" a little.   being off effexor onto Latuda (which sucked) was a ride.   

I was on the 37.5 of effexor and i guess my p-doc just doesn't want me to get all "dosed up" on cymbalta.

in your experience, what is the difference between effexor and cymbalta?   i was on effexor for 10 +/- years.   i'm also on Lamotrigine (450).   

 

Thanks.  Glad the Cymbalta is kicking in already, especially at just 30 mg!

In my experience, the difference between Effexor and Cymbalta was definitely mainly side effects... Effexor was waaaaay worse with side effects than Cymbalta was for me, but I was on a very high dose of Effexor (375-450 mg, and even more at one point), which seemed comparable to about 120 mg Cymbalta to me, except Cymbalta still had lesser side effects, even at that high of a dose.

That's a rather high dose of lamotrigine, but I've heard of people being on higher, but it shouldn't really affect the Cymbalta's efficacy in a negative way if you're wondering about that. If anything, it should help—that would be my guess. Are you on it for mood stabilization/depression or seizures?

[kaflyboy]

I was diagnosed with BP2 albeit i'm seeking a second opinion next week.   i used to be up and down all the time.

the Lamotorigine, i think that is for anxiety/ racing thoughts.   when i took the first pill i remember it was like a silver bullet, hit the spot.    

anything i should mention to the second opinion person next week?   the are simply a med management group.   

i also feel much better when i have a little caffeine in my body (focusing standpoint).

seems like you have tried every med on the planet.   are you someone that these drug companies study?

[mikl_pls]

6 minutes ago, kaflyboy said:

I was diagnosed with BP2 albeit i'm seeking a second opinion next week.   i used to be up and down all the time.

the Lamotorigine, i think that is for anxiety/ racing thoughts.   when i took the first pill i remember it was like a silver bullet, hit the spot.    

That's how lamotrigine was for me at first too. It was magic. It practically saved my life...

6 minutes ago, kaflyboy said:

anything i should mention to the second opinion person next week?   the are simply a med management group.   

i also feel much better when i have a little caffeine in my body (focusing standpoint).

3

I can't think of anything extra in particular. If it were me in your situation, I would just mention my history with the Effexor and Latuda and their effects on you, plus I would mention what you said about feeling better when you have a little caffeine in your body from a focusing standpoint (may be a sign that you need a stimulant?).

8 minutes ago, kaflyboy said:

seems like you have tried every med on the planet.   are you someone that these drug companies study?

 

Hahaha!! Yeah I've been around the medi-go-round quite a bit. No, I'm not someone who drug companies study, though I've wondered if they should ... lol. I'm just very, very treatment resistant.

[kaflyboy]

Thanks for your insight.  

One thing I like about cybalta is I don't feel as hungry.  Effexor I was hungry all the time.  Do you think after a week I have the full "benefit" from the 30?   Ie it's all the way in my system and working properly?

[mikl_pls]

Of course.  

Yeah, I got the munchies on Effexor too, which is strange because "anorexia" is listed as a side effect.

Well, if we go by the half-life of Cymbalta, which is 12.1 hours, it takes about 5 half-lives to achieve steady state plasma levels, which for Cymbalta would be 60.5 hours or about 2½ days. So someone please correct me if I'm wrong, but my guess would be that it's safe to say that it's in your system for sure, but whether it's "working properly" or not is another thing altogether I believe. That depends on the state of your receptors (the degree to which they're downregulated, etc.), as well as many other variables that I'm not sure about. The fact that you were on an antidepressant before helps that. So you could be feeling the full benefits of 30 mg within a week, or it could be several weeks before you realize the full benefits 30 mg will have for you. It really just depends. But if you reach a "plateau" so to speak at 30 mg at any point, you will probably have to go up to 40 mg or the full 60 mg.

[kaflyboy]

thanks for the info.   

How did cymbalta come are to Effexor for social anxiety?

[mikl_pls]

Hmm... I'd say Effexor was probably a little better for me for social anxiety, but Effexor pooped out really quick on me. Cymbalta's effects were way more consistent for longer than Effexor's for me. That's just my experience though, YMMV. 

[kaflyboy]

One thing I have noticed is how tired I get a night.  Around 9 I can't stay awake.  I slept from 10:30 - 8 last night.  I've never had a problem sleeping but the cymbalta really knocks me out around 9.  

Im only a week into taking it.  Will this slow down or get worse over time?

[mikl_pls]

I can't say because I personally never had that problem with Cymbalta. It was very stimulating for me.

[kaflyboy]

Hey guys-

another question.   It's around 7est and I'm feeling pretty "down".  I took 30 of cymbalta around 8am today.  Does it wear off after a while?   How do you know when you're on the right dosage?   

Wht about taking it before bed?   I've been on it for about a week. 

[mikl_pls]

19 hours ago, kaflyboy said:

Hey guys-

another question.   It's around 7est and I'm feeling pretty "down".  I took 30 of cymbalta around 8am today.  Does it wear off after a while?   How do you know when you're on the right dosage?   

Wht about taking it before bed?   I've been on it for about a week. 

 

 

It shouldn't wear off throughout the day, but that all depends on the speed of your metabolism, like if you're a rapid CYP2D6 and/or CYP1A2 metabolizer, which are the liver enzymes by which Cymbalta is metabolized. I'd personally say you'll know when you're on the right dosage when you don't feel "drugged" or feel like you are aware of the medicines effects on you or fluctuations of effects like you're describing. To me, I think when a medicine is working, it should feel innocuous to where you don't know you're taking it due to its working right. I hope that makes sense, I'm having difficulty articulating what I'm trying to say...

If you end up switching to the 60 mg full dose and still have the "wearing off" effect, what you could do to mitigate this is switch from taking it in all one dose to taking it in two doses: 20 mg twice a day (40 mg) or 30 mg twice a day (60 mg)—1 in AM + 1 in afternoon is typically how it's taken from what I've heard and personally how I've taken it myself. Hopefully, that would help that problem if you are still faced with the "wearing off" effect when/if you switch to the full 60 mg dose.

If it were me, personally, I wouldn't take Cymbalta before bed simply because of its tendency to be stimulating and could cause insomnia; however, if you're just absolutely outright sedated during the day from it and are having difficulty tolerating it, then, by all means, do give it a try at bedtime. Just be careful and vigilant about any first signs of insomnia, which if that happens, I would immediately switch back to taking it during the morning, even if it's still sedating if taken in the AM.

However, if 30 mg is sedating you during the daytime, it could be because it is over-tuning your noradrenergic system. In other words, at modest levels, norepinephrine can improve prefrontal cortical function by stimulating postsynaptic α_2A-adrenergic receptors, but at high levels, too much noradrenergic stimulation can lead to impaired working memory (and I believe sedation too) when α₁ and β₁ receptors are stimulated too. So if after several weeks of 30 mg during the daytime and you're still sedated, you may wish to ask your pdoc to try 20 mg for the time being until you get used to the noradrenergic stimulation and until your receptors downregulate, then you may be able to move up in dosage and be able to tolerate it better. This is actually a common side effect from what I've heard and read of the selective norepinephrine reuptake inhibitor, Strattera, especially when up-titrated too rapidly.

Edited November 21, 2016 by mikrw33

[kaflyboy]

Man, you're brilliant.    Not sure how much studying you have done (formal) but you know more than most docs i have seen.

I took the 30 last night before bed and did wake up a few times but it was manageable.   I feel better today, not as "down" as yesterday albeit my mind is still kind of racing.

so summary is:

1) stay on the 30, take at bed as long as i can sleep

2)  continue to ride out the 30mg and let it "sink into" my system.   It might not be there yet.

I'm meeting with a new p-doc Wednesday who specializes in med management.   i'm looking forward to his opinion.

i take my lamotrogine in the mornings, 450.   i wonder if i take the cymblata at the same time if it's too much for my system to digest.   probably not, just thinking out loud.  

one good thing, the Cymbalta has curved my appetite vs. the effexor.   the effexor, i was starving all the time.   couldn't eat enough cookies.   

you noted the ideal dose of cymbalta is 60.   why is that the case?

[mikl_pls]

27 minutes ago, kaflyboy said:

Man, you're brilliant.    Not sure how much studying you have done (formal) but you know more than most docs i have seen.

I took the 30 last night before bed and did wake up a few times but it was manageable.   I feel better today, not as "down" as yesterday albeit my mind is still kind of racing.

so summary is:

1) stay on the 30, take at bed as long as i can sleep

2)  continue to ride out the 30mg and let it "sink into" my system.   It might not be there yet.

I'm meeting with a new p-doc Wednesday who specializes in med management.   i'm looking forward to his opinion.

i take my lamotrogine in the mornings, 450.   i wonder if i take the cymblata at the same time if it's too much for my system to digest.   probably not, just thinking out loud.  

one good thing, the Cymbalta has curved my appetite vs. the effexor.   the effexor, i was starving all the time.   couldn't eat enough cookies.   

you noted the ideal dose of cymbalta is 60.   why is that the case?

 

 

Wow, I'm quite humbled! (^^ゞ Thank you!

So you take all 450 mg of your lamotrigine in the mornings? You don't divide it up into two doses or whatever? Usually, lamotrigine causes insomnia, but I suppose it isn't unheard of for it to be sedating, especially in such higher doses. I remember when I was on 400 mg lamotrigine I was so zoned out I could hardly concentrate on anything or think straight.

Good that Cymbalta is squelching your appetite. A ravenous appetite caused by a medicine is no fun. I'm trying to lose a bunch of weight that I gained from some meds I recently was on myself.

I'm not sure why the ideal dose of Cymbalta is 60 mg. That's just the way it is. That doesn't mean everyone has to be on 60 mg, though. If 30 mg or 40 mg works for someone just fine, then there's probably no reason to step up to 60 mg unless the 30 mg or 40 mg quits working as well. But everywhere I've read, 60 mg is the target dose for Cymbalta. Probably has something to do with all the testing they did with it, maybe it showed the most effectiveness? I haven't done that much studying into it that much.

Edited November 21, 2016 by mikrw33

[kaflyboy]

I take all 450 in the am.   Mainly convenience i guess, i've never been told to take it any other way.

My doc gives this to me for anxiety.   i suffer from social anxiety (the whole, what do people think of me) and i believe Lamotorgine is supposed to subside these concerns.   i do have a hard time with memory (ie- did i send this email to a customer, short term stuff).   Sometimes i suffer from confusion but it's all manageable.   

I also have ADD (or ADHD) which i was being treated for with effexor.   "hypo-mania" was a disorder which my doc prescribed as bi-polar 2.   

i often wonder if i should have something (like Ritalin) to help with focus.   a friend takes some after lunch and swears by it. 

based on what i have written, have you seen others with my condition have success with my concoction of meds?

[mikl_pls]

Interesting. Do you take 150 mg x 3 or something? I've always been told to divide it up twice a day whenever I took it, but that's just me. I suppose the half-life is long enough to where it probably doesn't matter after all, although I did read somewhere on here recently that the orally disintegrating tablet version of lamotrigine has to be taken up to three times a day. That's an interesting reason for taking lamotrigine, I've never heard of it being taken for anxiety, but glad that it helps you with that! At first, for me, lamotrigine increased my anxiety levels but then evened out after a little while, which I've heard is typical. Oh god the memory problems... That's one of the main reasons why I quit lamotrigine. That and the hair loss, the vitamin D deficiency, the acne, the rashes, all that stuff. Other than that, it was a miracle drug.

Effexor for ADHD huh? Interesting. I guess I've heard of it being used for that, but I don't think it's first-line treatment for that. So you're bipolar II as well? Most people with bipolar can take stimulants with no problem. I don't have the link handy, but sometimes stimulants can have a mood-stabilizing effect, particularly the amphetamines. Huh, Ritalin is usually dosed before food from what I understand (30-45 minutes before food).

With your combination of meds, do you mean Cymbalta + Lamictal? I can't say exactly for sure if I've seen any success stories in particular, but I don't see why you couldn't have success with it, especially if your pdoc/med management team were to add a stimulant for your ADHD issues. With a stimulant on board, you may not even need to go to the full 60 mg of Cymbalta, or you may. It just depends on your reaction. This is just me guessing, but they may want to wait to see how you respond to Cymbalta before they add a stimulant or something, but then again if they are liberal with prescribing meds like that, they may prescribe you a low dose to start out with and gradually titrate you up to see how you respond.

[jt07]

Cymbalta was a tough med for me that didn't really work, but I know several people who swear by it including at least one on this board. I took 60 mg in a divided dose, so 30 mg am and 30 mg pm. About an hour after I'd take a dose, I'd become dysphoric. It was bad. Anyway, I have since learned that meds that affect NE (norepinephrine) hard are not for me. I take lamotrigine now but I wasn't taking it when I was on Cymbalta. 

[Gearhead]

It's been over a decade since I took it so don't ask me for specifics, but Effexor gave me nothing but side effects, and Cymbalta works well for me. I'm restarting it now and just took my first dose of 40 mgs. I was previously on 60 mgs. It worked for me for anxiety, and maybe for depression too, though I don't think that was specifically why I was taking it.

[kaflyboy]

Mikrw33-

in your experience, does 30mg of Cymbalta equal roughly 37.5 mg of effexor?   i feel totally depressed right now...   no motivation at work, don't want to engage with any of my employees, not interested in doing a whole hell of alot...   pretty much burn't out...   looking for a way out of this gloom; minus the thousands i have spent on therapy through the years.

[jt07]

8 minutes ago, kaflyboy said:

Mikrw33-

in your experience, does 30mg of Cymbalta equal roughly 37.5 mg of effexor?   i feel totally depressed right now...   no motivation at work, don't want to engage with any of my employees, not interested in doing a whole hell of alot...   pretty much burn't out...   looking for a way out of this gloom; minus the thousands i have spent on therapy through the years.

For most people, 30 mg of Cymbalta is not a therapeutic dose. When I took it, the target dose was 60 mg with the option to go higher if need be. So if you are still depressed at 30 mg, take some comfort in the fact that you are still not at a therapeutic dose.

[kaflyboy]

Thanks jt-

i went to a new p-doc (just a med management guy) as my psychiatrist is an hour away, one direction.  

my problem is how to get "what's inside to the outside"...   ie- explaining to others how i feel.   after doing a "depression test", many of the things on the test resonate with me.   

right now i fell kind of "numb" low energy, just kinda crappy.   hopefully someone will suggest that i go to 60 on the cymbalta (doc).

back to line item 2, does anyone have a "test" or a document that i could fill out that might help zero in on how i'm feeling?

[jt07]

I don't have any tests, but have you considered just writing out how you are feeling in the inside when you are at home and calm and not nervous. Then you could take the document in with you when you see your doctor. That can sometimes help when you have trouble getting out what you want to say but are nervious.

[kaflyboy]

Hey JT-

how do you define a "therapeutic dose"?   ie- what does that mean?

[jt07]

A therapeutic dose is a dose that is an effective dose that is prescribed - neither too much nor too little.

[mikl_pls]

4 hours ago, kaflyboy said:

Mikrw33-

in your experience, does 30mg of Cymbalta equal roughly 37.5 mg of effexor?   i feel totally depressed right now...   no motivation at work, don't want to engage with any of my employees, not interested in doing a whole hell of alot...   pretty much burn't out...   looking for a way out of this gloom; minus the thousands i have spent on therapy through the years.

 

 

 

I never took Cymbalta at 30 mg for long, but according to charts online (like this one), Cymbalta 20 mg is equivalent to Effexor 75 mg, so Cymbalta 30 mg would be equivalent to Effexor 112.5 mg (75 mg + 37.5 mg).

Like @jt07 mentioned, 60 mg is the target dose and 30 mg is often not therapeutic for most people.

 

5 hours ago, kaflyboy said:

back to line item 2, does anyone have a "test" or a document that i could fill out that might help zero in on how i'm feeling?

3

Do you mean like a "mood test?" I've used www.moodscope.com/ and http://www3.psychcentral.com/quizzes/mood-tracker/ before. They ask you questions that you answer and yield results that can be tracked if you create an account.

 

 

3 hours ago, kaflyboy said:

how do you define a "therapeutic dose"?   ie- what does that mean?

 

 

A "therapeutic dose" is a dose that may be required to produce a desired effect, in this case, an antidepressant effect.

 

[kaflyboy]

Thanks for the info guys.  I sure as heck hope things stabilize soon.  I can't stand feeling so "grey".  

Based on the chart, I might be on too much cymbalta (30) if 37.5 of Effexor was working before coming off of it 

I spoke with my doc tonight and she said to maybe go up to 60 on cymbalta so I'm gonna try that tomorrow.  Whatever needs to happen, I hope it happens quickly!!!

i really appreciate everyone walking me through this rough time while things get balanced.  

[kaflyboy]

Hey guys-

today was MUCH better.  I took 60 of cymbalta this morning.  I'm not sure if it was just between my ears or if there was a legitimate reaction, but I immediately (around 10am) started feeling more relaxed, focused, present.  

[jt07]

50 minutes ago, kaflyboy said:

Hey guys-

today was MUCH better.  I took 60 of cymbalta this morning.  I'm not sure if it was just between my ears or if there was a legitimate reaction, but I immediately (around 10am) started feeling more relaxed, focused, present.  

That sounds promising! 

[mikl_pls]

Great! Hope it keeps working that way!

[kaflyboy]

Am I nuts (wait don't answer that) but an increase isn't supposed to work immediately is it?   It might not have soaked in you but something is different 

[kaflyboy]

 Hey guys, wanted to follow up on this  thread. Question, I started taking 60 of Cymbalta last week and I felt great for a couple days. Over the weekend and today I started feeling a little low again. 

 Could it be my brain was reacting positively to be stimulant of the additional 30 of Cymbalta and has now leveled off? 

 

[jt07]

This is a fairly typical antidepressant response where you feel great at first and then come back down a few days later. This is why you can't make a judgment on how an antidepressant is going to work for several weeks. Give it some time.

[kaflyboy]

That's the bad part...   i'm so impatient.   When i hit the 60 i was like "yes, i found it!!!"   the right mixture.   that was last Tuesday- Thursday when i went from 30-60. Over the weekend i started to "come down" feeling blah.   

Today i'm not motivated at all (at work) feel sad and tired.   kind of want to crawl into a hole.   

is this a typical reaction or do you think i need to consider going to 90?   i'm meeting with my p-doc tomorrow and would like to have some suggestions/ feedback for him.

[kaflyboy]

I have noticed that while on 60 I feel sluggish.  Yawning a lot.  If I go to 90 should I expect the same?   

I really thought I was out of the woods when I went from 30 to 60.  Now I feel like I'm back in a bad place.  

[kaflyboy]

Hey guys...   what are your thoughts on adding Adderall?   My goal would be to increase my motivation and focus on tasks.   I own my own company and have to "get things done"...   ie- being a positive leader, bringing in revenue, making sure things are flowing smoothly.  Right now i could give a crap less about work or anything else for that matter.   

thoughts?

[kaflyboy]

Hey guys is anyone still on this thread?   I've got a few updates to report and would like opinions if anyone is still following this chain 

[mikl_pls]

I'm still following. Feel free to share.

[kaflyboy]

Thanks Mik-

i started taking the prozac (10 mg) at full dose (10mg) last Friday the 9th.   today is the first day that i have not felt totally 100% depressed.  

i'm taking the 450 of lamotrigine in the am and it seems to sustain me better throughout the day vs. the 225 in the am and 225 at night.

on the prozac, is this about the timeframe it takes to "kick in"?   any other thoughts from your end?

[jt07]

Prozac is generally thought to take longer to kick in due to it's long half life. As always, you have to give it six to eight weeks for full efficacy. Ten milligrams is a low dose so you have a LOT of room to go up if you need to.

Wow, it's hard to believe Cymbalta and Prozac ... those were two of my worst ADs (other than the tricyclics). I know they help a lot of people but both left me dysphoric and I was ragey on Prozac. But that's me. The important thing is whether it helps you.

Are you still taking Cymbalta or did you give it up in favor of the Proazc?

[kaflyboy]

I gave up on the Cymbalta.   When i went to 60 it made me "cycle"...  meaning, my highs were good, lows were really low.   My p-doc said that was a concern of hers.   that i would cycle on cymbalta.   

you use some terms to reflect moods that i have a hard time explaining.   ie- how to identify if you're ragey/ dysphoric.   is there a good way to find out "how i'm feeling" so i and describe better to my pdoc?   i'm seeing him monday and would like to give him an update.

you note the 10mg is low...  if i go up, what would the goal be to how i should be feeling?

[mikl_pls]

Indeed Prozac is thought to take longer to kick in, as @jt07 said, due to its long half-life, but one can experience benefits in as little as a week or so if one has already been on an antidepressant. I can't explain why, but my pdoc said it takes less time to respond to an antidepressant if one is switching from one to another than if one is just starting out fresh.

How to identify if you're ragey /dysphoric? For me, ragey  means full of rage all the time, constantly flying off the handle at little things... Dysphoric is the opposite of euphoric—a state of unease or generalized dissatisfaction with life...

10 mg is low, but if you feel "normal" on it, then that would be your dose. Were it to lose its efficacy though you would, as jt07 said, have a lot of room to go up if you need to (generally up to 80 mg, but some have gone past that...).

 

[jt07]

Are you diagnosed with bipolar disorder?

I was ragey meaning that I had a short fuse and would go ballistic. I mean REALLY angry. Like Hulk angry. This was my reaction to Prozac. 

Dysphoric in the sense that I didn't feel like myself in a bad way. Not completely depressed but just bad and out of it. I felt the need to sleep to try to get over it. This is how I felt on Cymbalta.

The goal of any antidepressant is to no longer be depressed.

[kaflyboy]

you guys are great.   thanks so much.   it's been a dark time for me in the last few months and your support/ information has been extremely valuable   

[300.3]

Kaflyboy

 

We are lucky to have many great people on this board .. Especially Mike and Jt . There knowledge on meds is incredible. They will help you more then you know.

[kaflyboy]

hey guys-

a quick update on my condition.

since i have been on the 10mg of prozac, i'm feeling MUCH better.   it took about a week to "kick in".  i'm feeling much more focused, calm, getting things done.   headed in the right direction for sure.

however, today i feel like i might have "leveled out".   is this a common feeling?   also, i have not been hungry at all the last few days/ week.   almost a little nauseous.   today i have been pretty hungry, eating more than i have in the last few weeks.   is that something to be expected too?   i'm thinking this might be a parallel with the "leveling off"?

[jt07]

Hey, that's great to hear. Thanks for updating. It's always good to hear when an AD works for someone. It gives hope to the rest of us.

About the "leveling off" ... I'd say that it might be an indication that you need to increase the dose slightly. But, of course, I'm not a doctor and you should talk to your doctor about it. As I mentioned, 10 mg is a low dose. A lot of people are on 20 mg and it can go as high as 80 mg, I believe.

[kaflyboy]

Hey guys.  A quick update on my condition and looking for some suggestions. 

I felt awesome on Wednesday Thursday and Friday of last week.  Even Saturday.  This was as I was transitioning from 10 to 20 of Prozac.  Yesterday and today I started feeling like crap.  Down.  Depressed.  I saw my pdoc today and he told me to keep going up on the Prozac to 40.  

Here is the kicker.  I'm a recovering sex addic.  This was part of my mania for years.  My other pdoc (a psychiatrist) says that when I go up on AD my mania starts to kick in. 

So do you think that last week when I was doing awesome I was in a manic mood?   I was getting stuff done, very present, thoughts were fresh, felt really good.   This to be said, I'm not 100% sure she's right- that my mania gets higher when my AD goes up. 

Also he prescribed me a 1mg dosage of Guanfacine for add.  Any experience with that drug?

[300.3]

Prozac happens to be one ssri that takes longer then most ssri's to kick in. You are also on 10mg which is a low dosage. If your Dr suggests going up then follow what he suggests. So your going up 10mg a week?

As far as mania is concerned Jt and mik can weigh in.

[kaflyboy]

I just looked at my prescription and it's saying to take 2 20's so 40 on Prozac.  So that would be a double increase for this week. 

As a note- I own my own business and I think I'm a little burnt out.  I think that has something to do with my depression.  But I've always been able to "grind through it" when I was on Effexor (37.5).   

Edited December 20, 2016 by kaflyboy

[kaflyboy]

You guys still around?   My doc moved me up to 40 on Prozac.  Man I really feel like shit.  I am so unmotivated and have no fresh thoughts at work.  How long should I ride this out?   I'm just like blah.  Uggghhhh

[jt07]

I'm sorry you are feeling like crap because of the dose increase. Unfortunately, It's going to be like that until the Prozac kicks in which could take a few weeks. I'm really sorry to say that there is nothing you can do about it until then. I know how it feels though.

[kaflyboy]

Thanks JT.  I guess I'm questioning if I'm on the right stuff.  Even if I need an AD?  I feel like I'm looking around in a daze.   I have absolutely no motivation at work.  Don't want to get out of the bed.  

My gut is telling me I need to  be on Adderall as a supliment to give me some energy and fresh thoughts.  Your thoughts on that?   The more AD I take the worse I seem to get.  

[300.3]

Prozac will take some time to to work. Unless the dr suggested Adderall I would wait until the Prozac works.

[kaflyboy]

1 hour ago, jt07 said:

I'm sorry you are feeling like crap because of the dose increase. Unfortunately, It's going to be like that until the Prozac kicks in which could take a few weeks. I'm really sorry to say that there is nothing you can do about it until then. I know how it feels though.

 Hey J. T. I was on the chat board with psudodoc (sp).   I was telling him about some of your advice   and literally asked him if you were an inmate.     I'm not all that familiar with chat boards   He gave me the scoop.  My bad.  

[kaflyboy]

JT.  One quick question.  When you say "kick in", what would those feelings feel like?   Ie when will I know it's starting to have an impact?

[jt07]

When an antidepressant kicks in, you feel that your mood has markedly improved and your anxiety is markedly better. Sometimes it happens quickly while for others it happens over time. But you will know when it kicks in. There won't be any doubt.

As far as my thoughts on the Addrerall goes, I agree with 300.3 and would wait for the Prozac to work.

[kaflyboy]

 Thanks for the info J. T. I drug my ass out of bed this morning reluctantly.     Took 40 mg of Prozac.   

 Today I feel functional and a little bit lifted with my mood but still would prefer to be in the bed. 

 Do you thing that really stinks is I own my own company with about 14 employees. I have to be  available to them when needed which is why this is been so difficult. When I am on motivated at work I think it trickles down. 

 What is the quickest that you have seen an antidepressant work for someone?   I feel like I am hypersensitive to the  effectiveness     Maybe it's just between my ears 

[jt07]

The quickest? It's unbelievable and certainly not the norm, but I swear that Celexa worked for me within a day or two. Note that was Celexa (citalopram) not Prozac. Prozac has a long half-life and so it generally takes longer to reach steady-state which often translates to it taking longer to work. Generally with Prozac it's going to be a few weeks and, as I mentioned, unfortunately there's not much you can do about it.

I understand you needing to be 100% with your work. The side effects such as the grogginess and tiredness might go away faster than it takes for the med to start working. I had side effects with the Celexa but they went away in a week or two.

[kaflyboy]

Thanks JT.

i'm still feeling pretty good today.   I have a "manic state" when on AD's that comes and goes.  I'm hoping this is a "come" vs. "go" and things level off.

i was also prescribed an ADD med that is only 1mg for the first week and then 2mg the next week.  i'm wondering if that is helping too...

Again, i really appreciate you guys helping me get through this time.   I'm confident there is light at the end but getting there has been a real b*tch.

Oh, i'm kind of using this thread as a "journal" so i can cross reference dates and feelings.  Hopefully others that read it will benefit from my struggles.

Edited December 21, 2016 by kaflyboy

[mikl_pls]

2 hours ago, kaflyboy said:

i was also prescribed an ADD med that is only 1mg for the first week and then 2mg the next week.  i'm wondering if that is helping too...

What ADD med were you prescribed?

[kaflyboy]

29 minutes ago, mikrw33 said:

What ADD med were you prescribed?

I'll take a look tonight and let you know.   as i recall it was like a "Guam" something.   i can't remember the last part.   only 1mg.   

crazy, today has been great.   WTF, so strange the ups and downs.

[mikl_pls]

11 minutes ago, kaflyboy said:

I'll take a look tonight and let you know.   as i recall it was like a "Guam" something.   i can't remember the last part.   only 1mg.   

crazy, today has been great.   WTF, so strange the ups and downs.

 

Guanfacine?

[kaflyboy]

39 minutes ago, mikrw33 said:

Guanfacine?

That sounds correct...

Apparently it's sedating...   i take it at night.   i cant tell if it's doing anything or not...  Today was a better day.   whew

 

Edited December 21, 2016 by kaflyboy

[kaflyboy]

Mike you're correct on the add med.  any experience with it?

[Mr_Turtle]

I recently started taking Cymbalta for atypical depression and anxiety. Started at 30mg and got strong side effects within 48 hours (NAUSEA, dry mouth, electric skin, dizziness, general gross hungover feeling) and had a couple of days of being really hyperactive and giggly. Then it balanced itself out into a really striking positive effect. I'm still struggling to get up in the morning and be productive, but the existential black fog has noticeably cleared. I still think my life is currently shit, and I still get upset about unpleasant things, but to a degree that is proportional and more 'me'. All the CBT/mindfulness tricks are starting to work again and I am finding it easier to take pleasure in day-to-day activities instead of feeling an impending sense of threat/doom. I've noticed myself smiling for no particular reason and feeling a sense of wellbeing and warmth. Most importantly, the really severe crashes in mood have stopped and I'm not spending all my energy on trying to keep them at bay. I feel like I'm treading water now, but before I was trapped under the ice and drowning.

I'm supposed to be going up to 60mg this week but I'm still having moderate side effects and want to take it steady, so I'll probably wait until mid January.

 

In contrast, mirtazapine and citalopram did absolutely nothing for me. Venlafaxine gave me side effects but no beneficial effects. Sertraline gave me apocalyptic panic attacks multiple times a day. Quetiapine just knocked me out.

[kaflyboy]

4 minutes ago, Mr_Turtle said:

I recently started taking Cymbalta for atypical depression and anxiety. Started at 30mg and got strong side effects within 48 hours (NAUSEA, dry mouth, electric skin, dizziness, general gross hungover feeling) and had a couple of days of being really hyperactive and giggly. Then it balanced itself out into a really striking positive effect. I'm still struggling to get up in the morning and be productive, but the existential black fog has noticeably cleared. I still think my life is currently shit, and I still get upset about unpleasant things, but to a degree that is proportional and more 'me'. All the CBT/mindfulness tricks are starting to work again and I am finding it easier to take pleasure in day-to-day activities instead of feeling an impending sense of threat/doom. I've noticed myself smiling for no particular reason and feeling a sense of wellbeing and warmth. Most importantly, the really severe crashes in mood have stopped and I'm not spending all my energy on trying to keep them at bay. I feel like I'm treading water now, but before I was trapped under the ice and drowning.

I'm supposed to be going up to 60mg this week but I'm still having moderate side effects and want to take it steady, so I'll probably wait until mid January.

 

In contrast, mirtazapine and citalopram did absolutely nothing for me. Venlafaxine gave me side effects but no beneficial effects. Sertraline gave me apocalyptic panic attacks multiple times a day. Quetiapine just knocked me out.

It's amazing how you guys are able to identify all of these big words associated with how these drugs make you feel.  I just feel "better" or "worse".  I'm not sure how to identify the feelings as meds are adjusted.  Is there a website that helps dial identify symptoms?

[300.3]

It's a good thing not to over analyze how you feel .. it's actually a curse for me because I over analyze how I feel.  Plus many of us have tried different meds and can make comparisons to each one.

[kaflyboy]

27 minutes ago, 300.3 said:

It's a good thing not to over analyze how you feel .. it's actually a curse for me because I over analyze how I feel.  Plus many of us have tried different meds and can make comparisons to each one.

That's probably 96% of my problem.  Total over analyzing.  However I was completely out of it yesterday.  Not functioning.  

As JT said, you will know then the meds "kick in".  I felt like that today.  Wonder how tomorrow will be.  

[mikl_pls]

6 hours ago, kaflyboy said:

Mike you're correct on the add med.  any experience with it?

Nope, but I've taken a medicine in the same family as it (α₂ adrenergic agonists), clonidine (Catapres), and I did not fair well with it. It made me very sedated (which is more typical with clonidine than with guanfacine), and made me very depressed, not to mention it lowered my blood pressure too much and made me feel generally like crap. It didn't help with my ADHD or Tourette's, the two main reasons I was taking it for, nor did it help me with my hyperhidrosis, a secondary reason I was taking it. Basically, all I experienced from clonidine was side effects. I have been curious, however, about trying guanfacine. It's supposed to be much less sedating than clonidine, and it's more selective for the α_2A adrenergic receptor (the receptor responsible for benefits for ADHD) than clonidine, which is rather unselective, targeting α_2A as well as α_2B and α_2C, plus it's an imidazoline I₁ receptor agonist which mediates its blood presser-lowering effects as well as some of its sedating effects (along with the agonism of α_2B receptors I believe).

I do wish you luck on it. They make an extended release version of guanfacine (Tenex) called Intuniv (made by Shire, same people who make Adderall), not sure if you'd be interested in pursuing that or not. It's marketed for pediatric patients and has no indication for adult patients, so I don't know if you'd have trouble getting your insurance to cover it or not. But if the regular old version of guanfacine is working for you, then there's probably no need to switch Intuniv (don't fix something that ain't broken, right?)

6 hours ago, Mr_Turtle said:

I recently started taking Cymbalta for atypical depression and anxiety. Started at 30mg and got strong side effects within 48 hours (NAUSEA, dry mouth, electric skin, dizziness, general gross hungover feeling) and had a couple of days of being really hyperactive and giggly. Then it balanced itself out into a really striking positive effect. I'm still struggling to get up in the morning and be productive, but the existential black fog has noticeably cleared. I still think my life is currently shit, and I still get upset about unpleasant things, but to a degree that is proportional and more 'me'. All the CBT/mindfulness tricks are starting to work again and I am finding it easier to take pleasure in day-to-day activities instead of feeling an impending sense of threat/doom. I've noticed myself smiling for no particular reason and feeling a sense of wellbeing and warmth. Most importantly, the really severe crashes in mood have stopped and I'm not spending all my energy on trying to keep them at bay. I feel like I'm treading water now, but before I was trapped under the ice and drowning.

I'm supposed to be going up to 60mg this week but I'm still having moderate side effects and want to take it steady, so I'll probably wait until mid January.

In contrast, mirtazapine and citalopram did absolutely nothing for me. Venlafaxine gave me side effects but no beneficial effects. Sertraline gave me apocalyptic panic attacks multiple times a day. Quetiapine just knocked me out.

2

I'm glad the Cymbalta seems to be working well for you!

If you don't want to go up to 60 mg just yet, you can ask your doc/pdoc to prescribe you 20 mg to be taken twice daily for 40 mg as an intermediate step between 30 mg and 60 mg. They also make a 40 mg capsule, but it's expensive (if you don't have insurance), and it's generic only, so the pharmacist/pharmacy technicians get confused when they don't see "Cymbalta 40 mg" and instead have to look it up under "Duloxetine 40 mg." But anyway, just thought I'd mention that since you mentioned that you wanted to take things slowly. Also, if you really wanted to take things really slowly, after you get done with 40 mg, you could ask your doctor to prescribe you 30 mg and 20 mg as two separate prescriptions for 50 mg before you go to 60 mg (just an idea). You'd be paying extra for two separate prescriptions of Cymbalta, but it'd only be temporary until you go up to 60 mg.

Yeah, quetiapine really is just an antihistamine in lower doses and doesn't really have any real therapeutic benefit until you get to about 300 mg, and even then it's still debatable as to whether it's really efficacious or not.

http://psychotropical.com/anti-psychotics

6 hours ago, 300.3 said:

It's a good thing not to over analyze how you feel .. it's actually a curse for me because I over analyze how I feel.  Plus many of us have tried different meds and can make comparisons to each one.

 

I do the same thing and my pdoc has actually called me out on it lol. She said if I keep obsessing over how I feel and how my medicines are working, then it will actually keep my medicines from working the way they should.

 

[kaflyboy]

Thanks for the replies guys.

Question, when you guys start a new med or go up on a med, do you feel "different" when going up vs. when you level off?   for example, i went from 20 to 40 on Prozac in the last week.   While going up (yesterday for example) i felt really good.  Doing old things i used to do like calling people, being proactive, not reactive.   Today i feel a little "flat", not quite as motivated as yesterday.   

Any experience with going up or down on AD's and the impact it has on the short term mood?

Edited December 22, 2016 by kaflyboy

[mikl_pls]

6 hours ago, kaflyboy said:

Thanks for the replies guys.

Question, when you guys start a new med or go up on a med, do you feel "different" when going up vs. when you level off?   for example, i went from 20 to 40 on Prozac in the last week.   While going up (yesterday for example) i felt really good.  Doing old things i used to do like calling people, being proactive, not reactive.   Today i feel a little "flat", not quite as motivated as yesterday.   

Any experience with going up or down on AD's and the impact it has on the short term mood?

 

 

Well, when I was on Cymbalta and was on 60 mg, that worked for the longest time while I was on it; however, when it quit working, my pdoc didn't want to increase it, so we tried other meds. Long story put short, I eventually put myself back on Cymbalta but had some 30 mg and 60 mg capsules, and put myself on 90 mg and then told her about it at my next appointment. Only then did she agree to raise my Cymbalta, so I was on 90 mg for a few months which felt great, but after just a few months, I leveled off and felt flat and depressed again. I asked for another raise up to 120 mg, but she wouldn't do it, so we started augmenting with things like nortriptyline and Viibryd, none of which really worked that well.

I'm not sure if that answers your question, though... But yes, it is possible for you to level off after going up on the prescription. If the "leveling off" means that you're dipping down into a low mood, it could mean you're still not at a therapeutic dose, or it might not have "kicked in" just yet.

Like @jt07 has said, Prozac takes some time to start working for most people. For me, it took about a week and a half or so at 40 mg. But I was also on desipramine (Norpramin), a tricyclic antidepressant (TCA), which btw, Prozac + desipramine makes a kick-ass combo!

https://www.ncbi.nlm.nih.gov/pubmed/2009031

Desipramine in and of itself, I think, pulled most of the weight while I was on that combo, which was eventually switched to Cymbalta + desipramine, which didn't work nearly as well even while I was on Cymbalta 120 mg + desipramine 50-75 mg. The only reason I quit that combo was because I was gaining weight (likely the desipramine) and my resting heart rate was nearly always > 100 BPM, which was likely an interaction between my stimulant and the desipramine... apparently they don't get along too well, which is unfortunate. Otherwise, I'd probably still be on desipramine and probably just desipramine by itself.

Anyway, I digress. Give the Prozac a few weeks at this new dose, and if you don't feel something after 2-3 weeks I'd say, then you might need to go up to 60 mg or even 80 mg. If you don't have any results with that, you might look into augmenting the Prozac with something else, like say a tricyclic antidepressant like nortriptyline (Pamelor), desipramine (Norpramin), or protriptyline (Vivactil) (the secondary amine TCAs, which are much stronger in norepinephrine reuptake inhibition than in serotonin reuptake inhibition, thereby when combining it with the Prozac, you're creating your own "custom" SNRI which you can adjust the individual doses of the SRI and NRI to create a custom ratio, unlike the SNRIs on the market which are always at a fixed ratio of SRI-to-NRI).

I forget if you've taken any atypical antipsychotics or not, but that's also a possibility for an augmentative agent, something like aripiprazole (Abilify), Rexulti (brexpiprazole), Vraylar (cariprazine), quetiapine (Seroquel)/Seroquel XR (quetiapine ER), or olanzapine (Zyprexa)—Zyprexa is commonly paired with Prozac because they're both a 5-HT2C antagonist which disinhibits dopamine and norepinephrine release, exhibiting a synergistic and potent antidepressant effect when taken together. Seroquel is also a 5-HT2C antagonist, but not as potent as Zyprexa. The problem with those two antipsychotics (Seroquel and Zyprexa) is with weight gain, and with Zyprexa, diabetes. Abilify is usually weight-neutral and metabolically friendly for most people, as is Rexulti and Vraylar (Rexulti though, was not weight friendly for me, however... but that's just me). Vraylar doesn't have an actual indication for augmenting an antidepressant for depression, but my pdoc said it soon will likely gain approval for bipolar depression and augmenting an antidepressant for MDD.

[Mr_Turtle]

18 hours ago, mikrw33 said:

I'm glad the Cymbalta seems to be working well for you!

If you don't want to go up to 60 mg just yet, you can ask your doc/pdoc to prescribe you 20 mg to be taken twice daily for 40 mg as an intermediate step between 30 mg and 60 mg. They also make a 40 mg capsule, but it's expensive (if you don't have insurance), and it's generic only, so the pharmacist/pharmacy technicians get confused when they don't see "Cymbalta 40 mg" and instead have to look it up under "Duloxetine 40 mg." But anyway, just thought I'd mention that since you mentioned that you wanted to take things slowly. Also, if you really wanted to take things really slowly, after you get done with 40 mg, you could ask your doctor to prescribe you 30 mg and 20 mg as two separate prescriptions for 50 mg before you go to 60 mg (just an idea). You'd be paying extra for two separate prescriptions of Cymbalta, but it'd only be temporary until you go up to 60 mg.

 

 

Thanks mikrw! After trying multiple medications that made things worse it has been a huge relief to hit on something that seems to do its job.

I'm in the UK so I'm on generic duloxetine (just called it Cymbalta for the purposes of the boards) and don't have to worry about insurance or paying for prescriptions. Unfortunately they would never give me any of those intermediate doses - it's complicated enough just to get a simple refill of what I've already been prescribed in time before the packet runs out! I actually gave a Christmas card to my pharmacy yesterday because they've sorted out so many messes my doctor(s) have made over the past year. It's been a nightmare.

[Mr_Turtle]

On 21/12/2016 at 11:20 PM, kaflyboy said:

It's amazing how you guys are able to identify all of these big words associated with how these drugs make you feel.  I just feel "better" or "worse".  I'm not sure how to identify the feelings as meds are adjusted.  Is there a website that helps dial identify symptoms?

I find I can manage my moods much more effectively if I have a clear idea of what is going on that day, and it does get a little complicated. The depression and anxiety parts each get better or worse in a relatively simple way (not necessarily in sync though). But there are also times where I feel completely numb or have a 'stress high', which is often followed by a day of 'stress paralysis' or an extreme crash in mood, so I need to make sure I have food/water/blankets ready. And if I feel SO MUCH BETTER YEAH BEST FEELING EVER SO GREAT then I need to get an early night and avoid alcohol like the plague for a couple of days, until it passes. So it's not really over-analysing, it's just like taking a meter reading so I know what I need to do about it to stay healthy.

Most of the words I use to describe my mental health symptoms are non-scientific words or metaphors, which is weird because I've worked on clinical trials so I know all the proper words for the various adverse events. It just feels weird to use them about myself.  

[Flash]

I just started Cymbalta today, and I feel like I'm quite high, although it seems to be wearing off a little now. It feels like a cross between marijuana and ecstasy. It's sort of like hypomania without the motivation to clean or dive into some project, but there's a drug fog clouding everything. I'm certainly not complaining, because I've been so low for some time now, and right now the depression is just kind of lingering there in the background. 

Has anyone ever had this experience? I'm not sure if it's the Cymbalta, or an interaction of it with my other meds. I also started acamprosate last night, but I didn't feel like this then. I know Cymbalta interacts with doxepin, which I also take, but I wouldn't think that could cause this. It's not euphoria, but it's a close second. It definitely made my day a million times better, in any case. I wasn't expecting any kind of results for at least 6 weeks. I hope it's not a temporary thing that wears off quickly, because I feel quite good. On the other hand, I can't drive like this or play piano. On the ither hand, I feel like I could give up those things if this continues.

 

 

[kaflyboy]

2 hours ago, Flash said:

I just started Cymbalta today, and I feel like I'm quite high, although it seems to be wearing off a little now. It feels like a cross between marijuana and ecstasy. It's sort of like hypomania without the motivation to clean or dive into some project, but there's a drug fog clouding everything. I'm certainly not complaining, because I've been so low for some time now, and right now the depression is just kind of lingering there in the background. 

Has anyone ever had this experience? I'm not sure if it's the Cymbalta, or an interaction of it with my other meds. I also started acamprosate last night, but I didn't feel like this then. I know Cymbalta interacts with doxepin, which I also take, but I wouldn't think that could cause this. It's not euphoria, but it's a close second. It definitely made my day a million times better, in any case. I wasn't expecting any kind of results for at least 6 weeks. I hope it's not a temporary thing that wears off quickly, because I feel quite good. On the other hand, I can't drive like this or play piano. On the ither hand, I feel like I could give up those things if this continues.

 

 

Sounds like a pretty good place to be.  

I cant say that I experienced an up or down like you're having so immediate, but I have been like walking up stairs.  One step up, then flat, then a step up, then flat. It always seems to be while I'm going up on the dosage.  

If I were guessing I would say it's because you're going up and it should level off soon.  

[kaflyboy]

I've got zero energy this morning.  Have been  laying in the bed.  Sleeping on and off.  Wonder if the  1mg of guanfacine is knocking me out?     I take it before bed.  And I drank several beers last night.  Anyone have experience with alcohol and Prozac?

does anyone take Prozac at night?   I'm at a Christmas function and I'm totally exhausted even though I slept 12 hours last night.  Thinking about changing to night for taking Prozac.   Will the exhaustion go away over time?

Edited December 23, 2016 by kaflyboy

[mikl_pls]

3 hours ago, kaflyboy said:

I've got zero energy this morning.  Have been  laying in the bed.  Sleeping on and off.  Wonder if the  1mg of guanfacine is knocking me out?     I take it before bed.  And I drank several beers last night.  Anyone have experience with alcohol and Prozac?

 

No experience with alcohol and Prozac or alcohol and guanfacine (Tenex), but it is possible the guanfacine could be responsible for your sedation. It's supposed to be not as sedating as clonidine. It's very selective for the α_2A receptor, which doesn't produce any sedative effects (that's the α_2B receptor which does that). It could be the combination of alcohol and guanfacine that has you staying in bed.

It's also possible that the alcohol may be interacting with Prozac. Prozac raises allopregnanolone levels (a neurosteroid), which is a potent GABA_A receptor positive allosteric modulator (sort of like a benzodiazepine), plus fluoxetine and norfluoxetine are such modulators themselves as well. They act at GABA_A receptors with the α₄, and α₄β₃δ receptors are shown to have high steroid sensitivity compared to γ-subunit containing receptors (which are sensitive to benzodiazepines as long as the α-subunit is 1, 2, 3, or 5). Alcohol also modulates GABA_A receptors, targeting α₄β₃δ/α₆β₃δ subunits. So there could be a theoretical synergistic action with alcohol and Prozac with Prozac increasing allopregnanolone levels which modulates GABA_A receptors as well as Prozac itself, plus the alcohol modulating GABA_A receptors.

[kaflyboy]

2 hours ago, mikrw33 said:

No experience with alcohol and Prozac or alcohol and guanfacine (Tenex), but it is possible the guanfacine could be responsible for your sedation. It's supposed to be not as sedating as clonidine. It's very selective for the α_2A receptor, which doesn't produce any sedative effects (that's the α_2B receptor which does that). It could be the combination of alcohol and guanfacine that has you staying in bed.

It's also possible that the alcohol may be interacting with Prozac. Prozac raises allopregnanolone levels (a neurosteroid), which is a potent GABA_A receptor positive allosteric modulator (sort of like a benzodiazepine), plus fluoxetine and norfluoxetine are such modulators themselves as well. They act at GABA_A receptors with the α₄, and α₄β₃δ receptors are shown to have high steroid sensitivity compared to γ-subunit containing receptors (which are sensitive to benzodiazepines as long as the α-subunit is 1, 2, 3, or 5). Alcohol also modulates GABA_A receptors, targeting α₄β₃δ/α₆β₃δ subunits. So there could be a theoretical synergistic action with alcohol and Prozac with Prozac increasing allopregnanolone levels which modulates GABA_A receptors as well as Prozac itself, plus the alcohol modulating GABA_A receptors.

Holy smokes.  What a reply.  I'll read this off to my pdoc next week and see what he says.  

I'm feeling pretty crappy today.  Pushing through family Christmas stuff albeit I would prefer to be in the bed.  

Im thinking about Prozac tonight vs tomorrow for possible sedation.   I tend to feel better late in the evening (8ish) after I have taken Prozac in the am.  So maybe it's wearing off a little by the evening.

 

mike- one thing I forgot to mention, and it's starting to come back now, tennitus.  When I was going down off Effexor I experienced tennitus badly.  Now it's coming back as I'm messing around with this Prozac.  

Edited December 23, 2016 by kaflyboy

[mikl_pls]

7 hours ago, kaflyboy said:

mike- one thing I forgot to mention, and it's starting to come back now, tennitus.  When I was going down off Effexor I experienced tennitus badly.  Now it's coming back as I'm messing around with this Prozac.  

 

2

I tried researching tinnitus in relation to SSRIs and came up with mixed results... I read that tinnitus may be a result of low serotonin blood levels, and as such, SSRIs may be used to treat depressed individuals with tinnitus. But at the same time, I read that long-term use of SSRIs actually lowers serotonin levels in certain parts of the brain (don't know how credible that is, nor do I know how long exactly "long-term" means...). I also read that it's possible to have an ototoxic reaction to antidepressants, which is very rare, or it may be an interaction with the antidepressant and one of your other medications (you take Lamictal too, right?). Incidentally, when I looked up about tinnitus and lamotrigine, it, too, is a mixed bag when it comes to tinnitus: there are studies that evaluate the use of lamotrigine for the treatment of tinnitus (the one linked saying that it was effective "in a few of these individuals"), another link saying that tinnitus is an "infrequent side effect" of lamotrigine.

Ultimately, the recommendation I read, and with which I concur, is to consult an ENT specialist about the tinnitus.

Just FYI, here's an interesting link about pharmacological treatments for tinnitus that discusses (just to name a few of the mentioned therapies) the use of acamprosate (Campral), a medicine used for alcohol abuse to restore the balance between neuronal excitation and inhibition via effects on GABA and glutamate (according to Epocrates), which according to Wikipedia has been used successfully to treat tinnitus; alprazolam (Xanax), a triazolobenzodiazepine which you know I'm sure is used for anxiety, panic attacks, etc.; clonazepam (Klonopin), a 7-nitro benzodiazepine; Sabril (vigabatrin), an anticonvulsant which works by irreversibly inhibiting GABA transaminase (GABA-T), the enzyme that catabolizes GABA, thereby increasing GABA levels, and also induces tonic release of GABA by causing the GABA transporter to operate in reverse, which seemed to work in rat studies with noise-induced tinnitus, and thus is a potential drug candidate for a clinical study in tinnitus, but it is known that the drug can cause irreversible visual disturbances which limits its use in humans; lidocaine (Xylocaine), a local anesthetic also used to treat cardiac arrhythmias, which had mixed reactions, increasing the severity of tinnitus in some patients while decreasing it in others; carbamazepine (Tergretol, Tegretol XR, Equetro), an anticonvulsant which binds to voltage-gated sodium channels and stabilizes the sodium inactivation state, thereby reducing neuronal firing, as well as enhancing outward, voltage-dependent potassium currents, inhibiting L-type calcium channels, and enhancing the release of serotonin, for which the results were also mixed, seeming to indicate that among patients who responded positively to lidocaine, 56% had a good or excellent response to carbamazepine, whereas those who responded poorly to lidocaine also responded poorly to carbamazepine, while a more recent report found that among positive lidocaine responders, 50% responded positively to carbamazepine, 29% had no effect, 15% withdrew due to side effects, and tinnitus worsened in 6% of patients, indicating that carbamazepine may provide tinnitus relief in roughly half the patients who respond positively to lidocaine; nortriptyline (Pamelor), a secondary amine tricyclic antidepressant (TCA) that blocks reuptake of norepinephrine and to a lesser extent blocks reuptake of serotonin (thereby acting as a SNRI with stronger NRI than SRI) and also blocks certain serotonin receptors (5-HT_2A/2C) and muscarinic acetylcholine receptors, which was shown to be effective in severely depressed tinnitus patients, but had less benefit in nondepressed individuals; paroxetine (Paxil), which may be effective in depressed tinnitus patients; sertraline (Zoloft), which may be effective in tinnitus patients with depression and anxiety; misoprostol (Cytotec), a medicine used primarily to prevent gastric ulcers induced by NSAIDs and to induce labor, which may provide some benefit to tinnitus patients "with minimum risk, but larger studies are needed to confirm these trends before misoprostol can be considered of significant benefit for tinnitus"; and melatonin, especially when combined with the antipsychotic sulpiride (not available in the US).

Here's a case report of remitting tinnitus with the use of N-acetylcysteine (NAC), which you can get both as a ℞ and an OTC supplement. Looks like the dosage used in the patient described was 2000 mg/day, which you would likely need to gradually increase up to were you to try this regimen.

There's a supplement called "Lipoflavonoid Plus" that is supposed to be beneficial for tinnitus. Also, the nootropics piracetam and coluracetam I've read have been beneficial for tinnitus when used in combination with choline supplements such as CDP-choline or alpha-GPC (couldn't find any research on that, though).

Hope this helps.  

Edited December 24, 2016 by mikrw33

[kaflyboy]

Thanks Mike. Lots of info there.  

I abandoned the ADD med Guanfacine.  It simply knocked me out.  Driving home last night, hour road trip, I could barely stay awake.  

I took 40 of Prozac last night before bed vs my normal routine of taking it in the mornings.     I seem to feel better today even though I didn't want to really get out of bed this morning.  Went to some friends house for lunch then to church.  Felt pretty good.  Less zoned out than yesterday.  Maybe the Prozac is finally kicking in and the experiment of taking it at different times helped.  So, headed in the right direction I think.   Although in two hours I might be in a bad spot again.  Don't want to jinx anything 

[kaflyboy]

Hey guys.  Quick question.  

I took Prozac last night about 3 hours before bed.  Didn't sleep that well. Up early with kids.  Took my 450 lamotrigine.  Have been exhausted since this am.  

Live heard lamotrigine is sedating and Prozac stimulating.  Any thoughts on this sequence of events?   Maybe reverse it?

[jt07]

Lamotrigine can be either stimulating or calming, and it really depends on the person. A lot if not most people find it stimulating and take it in the AM. I can't advise you when you should take your meds, but it's a good question to ask your doctor or pharmacist. To me lamotrigine is neutral, and I can take it at any time and be ok.

Prozac and all SSRIs have a well-known start-up side effect of early awakening and insomnia. This will go away in a couple of weeks or so after a dose increase. You just need some time for your body to adjust to the new med or dose increase.

[dancesintherain]

I take 350 lamotrigine in the evening.  Last I saw, there was a straw poll here and it was a mixed bag.  So, so long as your doctor's okay with it, I don't see any harm to flipping and see if there's a difference.  Some also split doses.  I think it's a medication with a lot of variability on timing. 

I have no experience with Prozac, so I can't help on that one.

[kaflyboy]

Thanks guys.   I'll stay with the night dose tonight and see what happens.  Was pretty tired today but was able to push through the day.   

[AnxietyGirl74]

Most anti-depressants take 4-6 weeks to get into your system and start working well. 

[kaflyboy]

Hey dancing.  When you say lots of variability on timing, what's that mean?   I still feel like crap.  Can't drag myself out of bed and I have to go to work tomorrow!!!   Ugghhh

[kaflyboy]

Guys- I feel like absolute sh*t today.   So depressed.  Manic.  I'm beginning to think Prozac isn't the right med for me.  I'm nauseous as crap.  Haven't eaten all day.   When do you know when the med is right or wrong?   I'm calling my pdoc first thing in the morning.  

[jt07]

Nausea is an SSRI start-up effect that will go away in time. I think you should stick with your meds for at least six weeks or until your doctor says otherwise. Also, try to quit polling yourself on how you feel every day, Changes are measured in weeks and not in days.

[kaflyboy]

Thanks JT.  I'm coming up on 3 weeks on Prozac and I just feel like I'm slipping backwards vs forwards.  I did so well with 37.5 of Effexor for years.  I'm wondering if Prozac is the right class for me.  Sorry to be a pain, I'm just hyper sensitive to my mood.  I'm totally disengaged and unmotivated as hell   Been on couch all day with no desire to get off   

I remember when I first started lamotrigine.  It hit me like a ton of bricks (positive) within like 2 days and has been a good drug for me.  I'm just afraid the Prozac is making me manic and might not be the right class.  

[jt07]

Prozac has a very long half-life which means it takes weeks to reach a steady state in your blood. Don't give up on the Prozac yet. Also, you have to count the weeks from when you went up to 40 mg because your previous dose was very low.

[kaflyboy]

What are your thoughts about Prozac vs Effexor and being in different classes?   I.e. Effexor worked well for years in different class.  

[jt07]

While Effexor is classed as an SNRI, at low doses (less than 150 mg) it acts mainly as an SSRI.