Posted by bleauberry on January 25, 2009, at 14:55:28
In reply to Ixel [Milnacipran] Update: Day 5, posted by Mishal on January 25, 2009, at 3:23:18
Well, just a few comments.
The wellbutrin after-effects could linger for a couple weeks, so that could be getting mixed into the whole picture and confusing what Ixel by itself feels like at this point.
The nausea and lightheadedness are probably the most common side effects. Comments from studies and people that have gone the course with Ixel say those side effects disappear at about 4 weeks, except at the very high dose of 200mg where they seem to stay. And again, after effects of Wellbutrin could be playing into all that.
Was the Ativan ongoing before Ixel? It by itself could be causing a worsening of mood while helping side effects.
I've tried to get on Ixel several times. The longest was 2 weeks at 18mg (6mg 3 times per day). The thing that always stopped me was it tightened up my left wrist so bad I could hardly play guitar. There is only one thing I've done all my life and am extremely good at, and that is guitar. I had tendonitis years ago, healed by surgery, and Ixel just flares it up badly. I could deal with the lessened appetite and stuff.
I too got a paradoxical worsening at about day 3. Day 1 is neutral or decent, day 2 is noticeably good, then day 3 it goes backwards, and then by day 7 or so it creeps forward again. I read somewhere it has to do with the rapid desensitization of the 5ht1a receptor which takes about 5 days.
One study compared 100mg Ixel once per day to 20mg Prozac. Prozac did better. It was blamed on the inappropriate dosing of Ixel. But, that doesn't mean there was no one in the Ixel group that didn't do great. It was just the overall stats, not individual cases.
To get multiple doses during the day, I wonder if you could make smaller more frequent doses? With empty gel caps size 00 from the health food store you can make your own sizes. Spread 25mg in small doses over the day and then a single 25mg at bed? Just a thought.
I did see a couple case reports at pubmed where people were successfully treated with just 25mg once per day. The comments were that lower single doses do work, but that they take significantly longer to do so. Maybe if that prozac study had gone on another 4 to 8 weeks that would have happened?
I tell you what, I am a fan of Ixel, regardless that I haven't figured out a way to tolerate it. I mean, here's a person who has been on every SSRI, SNRI, lithium, depakote, lamictal, zyprexa, modafinil, two TCAs, a few overseas meds, all kinds of combinations of them, and ECT, and in all cases I either got worse, had totally intolerable side effects, or got no benefit. And yet, one unsuspecting med comes along that actually showed me a lot of promise...Ixel. Imagine that. A med has to be pretty good to do that I think. A med that actually works faster and better than ECT? Well, it did for me.
I have browsed forums where longterm users of Ixel hang out. Most of them were for Fibromylagia, others for depression. There was a general trend to be seen. That is, the longer on the drug, the better things get. One person wasn't truly in remission from depression until 10 months on Ixel. But, remission it was. Another said FM symptoms really didn't start to lessen significantly until 3 months. I guess the biochemical changes that are needed take some time, but Ixel has the power and mechanism to do those changes.
I could be wrong, but my gut instinct says to hang in there and be tough. Those that got the most benefit did that. Maybe I need to do that. I mean, after all, if not Ixel, what is the next option? There really aren't any good ones, ya know? It might be worth giving it your all first? Maybe? Gosh, I'm talking to myself here too. :-)
> Hi
>
> As blueberry suggested, I stopped taking Wellbutrin to go with Ixel. Started on wednesday 25 mg at noon and same amount at night. Still found it hard to tolerate daytime dose so, have been changed to 50mg once at night along with Ativan 2mg. (Nausea and lightheadedness are troublesome if it is not mixed with Ativan. I read it somewhere Ativan has some anti-emetic properties)
>
> Today, it seems like paradoxical worsening of depression (the most troublesome) has been lessening and I am bit okay. This is the fifth day on it. I know there is a long way to go. But my concern is of the half-life of this drug. It shows 8 hours only which means I have to dose it at least twice a day. I am okay with once at night dosing. But is it necessary to take twice daily? Are there patients who take it all at once and feeling well?
>
> Awaiting your responses.
poster:bleauberry
thread:876017
URL: http://www.dr-bob.org/babble/20090104/msgs/876111.html