dumbdoo Posted December 11, 2017 Share Posted December 11, 2017 Hello there, I'am taking Duloxetine 120mg for Depression and Pure O (OCD) since Feb. 2017. Unfortunately, I still have intrusive thoughts and some symptoms of depression (low mood, no energy etc.), although I can handle my everyday life somehow. However, the whole situation is not satisfying for me and my family. I'm constantly tired, lethargic, grumpy, hungry and unhappy. So what's next? I've already tried to augment with Seroquel (300mg; horrible, horrible experience) and Abilify (2,5mg-5mg, quit working after two months). What's about switching the baseline med? Can I go back to SSRIs like Citalopram, Fluvoxamine or Paroxetine?* Or is it pointless, since the doctors kept telling me that Duloxetine and Venlafaxine were far more potent than the SSRIs... *Lexapro did considerably well in the past, but it unfortunately pooped out after two years. Sertraline did nothing for me (I'm an ultra rapid metabolizer). Link to comment Share on other sites More sharing options...
dtac Posted December 11, 2017 Share Posted December 11, 2017 5mg of Abilify is pretty low, lots of room for increasing the dose there. If it was working, why not try increasing the dose a bit higher? Link to comment Share on other sites More sharing options...
Iceberg Posted December 12, 2017 Share Posted December 12, 2017 Rexulti too if ur insurance will cover it. I liked it better than abilify Link to comment Share on other sites More sharing options...
jt07 Posted December 12, 2017 Share Posted December 12, 2017 I've taken all the SNRIs and nearly all the SSRIs (except the newest ones), and only Celexa (citalopram) and Lexapro (escitalopram) have done anything for me. So, yes, it makes sense to try SSRIs if SNRIs don't work. If I didn't go back to try SSRIs from the SNRIs then I wouldn't have found what works for me. 1 Link to comment Share on other sites More sharing options...
dumbdoo Posted December 12, 2017 Author Share Posted December 12, 2017 21 hours ago, dtac said: 5mg of Abilify is pretty low, lots of room for increasing the dose there. If it was working, why not try increasing the dose a bit higher? On 5mg I was tired the whole day, sleeping ~12-14 hours. And even after I decreased the dose back to 2,5mg, the exhaustion didn't vanish, so I had to stop taking it entirely. Maybe I should give it another try in the future. 18 hours ago, Iceberg said: Rexulti too if ur insurance will cover it. I liked it better than abilify Unfortunately Rexulti isn't available in Germany... 17 hours ago, jt07 said: I've taken all the SNRIs and nearly all the SSRIs (except the newest ones), and only Celexa (citalopram) and Lexapro (escitalopram) have done anything for me. So, yes, it makes sense to try SSRIs if SNRIs don't work. If I didn't go back to try SSRIs from the SNRIs then I wouldn't have found what works for me. Okay, that's good to know. Maybe I'll ask my pdoc about Celexa. There's still the possibility, that my problems are dose-related. 120mg of Duloxetine are seldom described (according to the pdoc) and could definitely cause some adverse effects like tiredness or increased anxiety, which both are contributing to the feelings of depression. It's an awkward situation, 'cause I need the highest dose to help me with the Pure O stuff. Link to comment Share on other sites More sharing options...
protectmepls Posted December 20, 2017 Share Posted December 20, 2017 (edited) On 12/12/2017 at 8:03 PM, dumbdoo said: On 5mg I was tired the whole day, sleeping ~12-14 hours. And even after I decreased the dose back to 2,5mg, the exhaustion didn't vanish, so I had to stop taking it entirely. Maybe I should give it another try in the future. Unfortunately Rexulti isn't available in Germany... Okay, that's good to know. Maybe I'll ask my pdoc about Celexa. There's still the possibility, that my problems are dose-related. 120mg of Duloxetine are seldom described (according to the pdoc) and could definitely cause some adverse effects like tiredness or increased anxiety, which both are contributing to the feelings of depression. It's an awkward situation, 'cause I need the highest dose to help me with the Pure O stuff. I think your pdoc is right the dose of Duloxetine you are on actually increases tiredness and other side effects, the highest I've been on is 90mg. You can try to add something stimulating like Modafinil or Vyvanse. It says in a book I own: concentration + fatigue require NE/DA action so prescribing NDRI, NRI, SNRI, MAOI (Modafinil, stimulant, atypical antipsychotic, Li/thyroid/L-methylfolate/5HT1A agonist) Also, I've heard lower doses of Abilify (Aripiprazole) are more activating than higher doses. Have you tried any other antidepressants? There could potentially be a better antidepressant for OCD? Edited December 20, 2017 by cryinginmoscow Link to comment Share on other sites More sharing options...
dumbdoo Posted December 20, 2017 Author Share Posted December 20, 2017 3 hours ago, cryinginmoscow said: I think your pdoc is right the dose of Duloxetine you are on actually increases tiredness and other side effects, the highest I've been on is 90mg. You can try to add something stimulating like Modafinil or Vyvanse. It says in a book I own: concentration + fatigue require NE/DA action so prescribing NDRI, NRI, SNRI, MAOI (Modafinil, stimulant, atypical antipsychotic, Li/thyroid/L-methylfolate/5HT1A agonist) Also, I've heard lower doses of Abilify (Aripiprazole) are more activating than higher doses. Have you tried any other antidepressants? There could potentially be a better antidepressant for OCD? Yeah, i tried Lexapro, which was great for OCD until it pooped out. Worked definitely better than duloxetine. On so many levels. Tomorrow I will take agomelatine for the first time. It‘s meant to help me with the fatigue, anhedonia and the disturbed sleep pattern due to its 5HT2C antagonism (which should release more NA/DA in certain parts of the brain, at least in theory). Strangely Abilify was pretty activating for me in the beginning, therefore I wouldn’t call it a catastrophe. I still don‘t know what happened in the meantime. Link to comment Share on other sites More sharing options...
protectmepls Posted December 20, 2017 Share Posted December 20, 2017 2 hours ago, dumbdoo said: Yeah, i tried Lexapro, which was great for OCD until it pooped out. Worked definitely better than duloxetine. On so many levels. Tomorrow I will take agomelatine for the first time. It‘s meant to help me with the fatigue, anhedonia and the disturbed sleep pattern due to its 5HT2C antagonism (which should release more NA/DA in certain parts of the brain, at least in theory). Strangely Abilify was pretty activating for me in the beginning, therefore I wouldn’t call it a catastrophe. I still don‘t know what happened in the meantime. Hope you see the change you want. And keep us updated if you need to. Link to comment Share on other sites More sharing options...
mikl_pls Posted December 22, 2017 Share Posted December 22, 2017 Sometimes OCD patients need supratherapeutic doses of SSRIs, like people taking Lexapro, they may need as much as 40 mg or so, for example... So if you perchance revisited it, maybe you could ask to try higher than 20 mg to see if it helps. I wish you luck on the agomelatine (wish we had that in the US! lol)! Link to comment Share on other sites More sharing options...
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