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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Minnie-Haha on April 29, 2005, at 16:03:08
I haven't given a report in a while, so here goes.
First, I am a 46-year-old perimenopausal woman. I have three benign thyroid nodules, but my TSH is normal. I have chronic neck and upper-back pain from an old injury, which I treat as needed with OTC meds and very infrequently with muscle relaxants. My DXs are mild Bipolar Type II and mild OCD.
December 15, after 15 months of insomnia, anxiety, depression and nausea, I started taking Cymbalta. (I was already taking Trileptal: 150mg am, 300mg pm.) Before I started the Cymbalta my CES-D score was 36. (I LOVE that tool... http://www.dr-bob.org/babble/ometer/ ) Anyway, I started at 30mg and after 1 week, went up to 60mg. I found taking it in the morning made me sleepy during the day, so I started taking it in the late afternoon or evening. Most bothersome side effects were constipation and dry mouth, but nothing unmanageable.
By Jan. 15, my CES-D was down to 25. By Feb. 15, it was down to 10! I was sleeping better than I had in years and my daytime mood was generally euthymic, but I’d gained about four pounds, my blood pressure was up (into the prehypertensive range), and I was experiencing significant amotivation. We dropped the Cymbalta down to 40mg (because of the blood pressure) and added Bupropion 75mg. Tried that for two weeks, but my appetite stayed up and my motivation down.
On March 15, my CES-D was back up to 25. (I really missed those extra 20mg of Cymbalta. Neither my sleep quality or my daytime mood was as good as it had been.) Next, we switched from the generic Bupropion to Wellbutrin XL 150mg for about a month. That improved my mood a little -- my April 18 CES-D was up to 19 -- but messed with my sleep even more. And it didn’t help with the amotivation or appetite. (By this time, I’d gained about 10 pounds on Cymbalta.)
So on April 19, we traded the Wellbutrin XL for Wellbutrin SR 200mg. I have definitely seen a decrease in my appetite (I’ve lost two pounds) and an increase in my activity level. In fact, it might be a little too activating. I’m going to ride it out for 2-3 more weeks if I can, and if that doesn’t even out, I might ask my pdoc to drop it to 150mg.
I hope I can get back on Cymbalta at 60mg someday. We think it’s a possibility, if I can continue to take my weight (and blood pressure) back down. Wish me luck!
Posted by Minnie-Haha on April 29, 2005, at 16:13:50
In reply to On Cymbalta 4 1/2 months now, posted by Minnie-Haha on April 29, 2005, at 16:03:08
FWIW. I've noticed since I started the Wellbutrin SR (200mg), it seems like my neck and cheeks get flushed and warm a few hours after taking it. (No mucous membranes involved though, and no fever, so I don't think it's SJS or TENS.)
I have sensitive skin anyway, so maybe it's no big deal. I live in Arizona and it's been getting warmer here, so maybe it's just the weather, but I think it's the Wellbutrin. FYI.
Posted by theo on April 29, 2005, at 18:14:29
In reply to On Cymbalta 4 1/2 months now, posted by Minnie-Haha on April 29, 2005, at 16:03:08
Do you take your Cymbalta as a morning single dose?
Posted by Phillipa on April 29, 2005, at 19:20:47
In reply to Re: On Cymbalta 4 1/2 months now » Minnie-Haha, posted by theo on April 29, 2005, at 18:14:29
Good luck Minnidhaha, I tried the cymbalta also but my Bp went up also. I didn't think it was helping me but when i stopped it all my aches and pains came back. Did it eliminate yours? Fondly, Phillipa
Posted by Sarah T. on April 29, 2005, at 23:05:00
In reply to On Cymbalta 4 1/2 months now, posted by Minnie-Haha on April 29, 2005, at 16:03:08
Hi Minnie Ha-ha,
Thanks for the update. Overall, it sounds as if you're doing better. I do have one question: You mentioned feeling significant amotivation. How was your motivation before you began Cymbalta? Was it comparable to the amotivation on Cymbalta? Do you think that the SSRI portion of Cymbalta might be causing the lack of drive? I have experienced amotivation on many antidepressants, particularly the ssri's, the worst one being Celexa; however, I even experienced some significant apathy on some of the old AD's like Elavil, imipramine, etc. It is very difficult for me to understand how something that causes and/or exacerbates apathy can be called an antidepressant. I have often asked my therapist, "What is the purpose of feeling more cheerful if I'm unable to move forward and do what I want and need to do?"
Posted by MidnightBlue on April 30, 2005, at 0:51:20
In reply to Re: Wellbutrin (SR) side effect?, posted by Minnie-Haha on April 29, 2005, at 16:13:50
In my experience, Wellbutrin makes you much LESS tolerant of heat.
Posted by SLS on April 30, 2005, at 9:52:18
In reply to On Cymbalta 4 1/2 months now, posted by Minnie-Haha on April 29, 2005, at 16:03:08
Have you thought to add pindolol? It is a beta-blocker with additional effects on serotonin function that seem to enhance the antidepressant response in some people. It will serve to reduce your blood pressure and allow you to continue at 60mg of Cymbalta. I would seriously consider using whatever dosage of Cymbalta that provides an optimal therapeutic response and treat the emergent hypertension.
- Scott
Posted by Minnie-Haha on April 30, 2005, at 13:11:56
In reply to Re: On Cymbalta 4 1/2 months now » Minnie-Haha, posted by theo on April 29, 2005, at 18:14:29
> Do you take your Cymbalta as a morning single dose?
No. I take it as a single late-afternoon or early-evening dose. Somewhere between 4:30 and 6:30 pm. I know it's kinda atypical, but it seems to work for me.
Posted by Minnie-Haha on April 30, 2005, at 13:13:30
In reply to Re: On Cymbalta 4 1/2 months now, posted by Phillipa on April 29, 2005, at 19:20:47
> Good luck Minnidhaha, I tried the cymbalta also but my Bp went up also. I didn't think it was helping me but when i stopped it all my aches and pains came back. Did it eliminate yours? Fondly, Phillipa
Oh my, yes, I didn't mention that. At 60mg it virtually wiped out my neck/back aches and pains... probably partly why I slept so well. At 40mg I'm not getting as good a benefit, but it's still better than before I started.
Posted by Minnie-Haha on April 30, 2005, at 13:27:31
In reply to Re: On Cymbalta 4 1/2 months now » Minnie-Haha, posted by Sarah T. on April 29, 2005, at 23:05:00
> Hi Minnie Ha-ha,
> Thanks for the update. Overall, it sounds as if you're doing better. I do have one question: You mentioned feeling significant amotivation. How was your motivation before you began Cymbalta? Was it comparable to the amotivation on Cymbalta?I was on NO AD before the Cymbalta, just Trileptal (and the occasional Ativan, Klonopin or Ambien to try to help me sleep), but of course Trileptal alone was doing nothing for my depression, so I had the kind of fatigue that is common with that (for me anyway). The amotivation on Cymbalta was, I was happy as a clam to just sit in my easy chair and watch daytime TV (which I never do), or read a book or a magazine. Took a great effort to get up and do the things that needed doing. (And that I guess is where it was like my pre-Cymbalta motivation.) However, that probably would have started to affect my mood eventually, because I don't like to just sit around and do nothing productive.
> Do you think that the SSRI portion of Cymbalta might be causing the lack of drive?I don't know, but it's a good question. Five years ago, when I was first on an MS and an AD at the same time (Depakote and Effexor) I had a good mood and plenty of motivation. (I was going to school full time -- including honors classes -- and loving it.) But over time, I started putting on weight (about 30 pounds in 2 years) and that started making me depressed. But that's another story... And before that (before my BP2 DX), I was on Zoloft for 4-6 months and it did a fine job on my mood and motivation, but I eventually got manic -- or possibly an anxiety disorder, which is why I'm not 100% sold on my DX, but that's another story too.
Posted by Minnie-Haha on April 30, 2005, at 13:29:11
In reply to Re: Wellbutrin (SR) side effect? » Minnie-Haha, posted by MidnightBlue on April 30, 2005, at 0:51:20
> In my experience, Wellbutrin makes you much LESS tolerant of heat.
It's comforting to know I'm not the only one experiencing that.
Posted by Minnie-Haha on April 30, 2005, at 13:32:08
In reply to Re: On Cymbalta 4 1/2 months now, posted by SLS on April 30, 2005, at 9:52:18
> Have you thought to add pindolol? It is a beta-blocker with additional effects on serotonin function that seem to enhance the antidepressant response in some people. It will serve to reduce your blood pressure and allow you to continue at 60mg of Cymbalta. I would seriously consider using whatever dosage of Cymbalta that provides an optimal therapeutic response and treat the emergent hypertension.
Thanks, Scott. We can always count on great advice from you. Would this do anything to help with the amotivation, or would I take it on top of the Wellbutrin? I'm beginning to feel like a walking cocktail, and I'm spending about $100 a month. (I'm also on Zocor for my cholesterol... which I'm hoping to discontinue if I can keep my weight going in a downward direction.)
Posted by Sarah T. on April 30, 2005, at 14:14:43
In reply to Re: On Cymbalta 4 1/2 months now, posted by SLS on April 30, 2005, at 9:52:18
Hi Scott. Can you tell me more about pindolol's additional effects on serotonin function?
Posted by SLS on April 30, 2005, at 15:11:49
In reply to Re: On Cymbalta 4 1/2 months now » SLS, posted by Sarah T. on April 30, 2005, at 14:14:43
> Hi Scott. Can you tell me more about pindolol's additional effects on serotonin function?
Pindolol blocks the 5-HT1a serotonin autoreceptors from "seeing" serotonin. These receptors are located somatodendritically. What this really boils down to is that the increase in serotonin produced by SSRIs is not allowed to signal the neurons to turn-off their production and release of serotonin.
- Scott
Posted by Sarah T. on April 30, 2005, at 19:45:44
In reply to Re: On Cymbalta 4 1/2 months now » Sarah T., posted by SLS on April 30, 2005, at 15:11:49
Thanks, Scott. Have you ever taken pindolol? I can't remember whether you've mentioned it.
Posted by SLS on May 1, 2005, at 7:02:52
In reply to Re: On Cymbalta 4 1/2 months now » SLS, posted by Sarah T. on April 30, 2005, at 19:45:44
> Thanks, Scott. Have you ever taken pindolol? I can't remember whether you've mentioned it.
None of my doctors were really enthused about pindolol. This includes a professor of psychiatry at NYU, the program that recommends pindolol as part of their treatment alogorithm. I've kept it on my list of things to try, though.
- Scott
Posted by lois on May 1, 2005, at 14:01:46
In reply to On Cymbalta 4 1/2 months now, posted by Minnie-Haha on April 29, 2005, at 16:03:08
Hi-
I am on Cymbalta 60 mgs and just started Wellbutrin 150 mgs XL for motivation.Just as you, I am looking for motivation without too much stimulation. *Just* motivation. I tried taking the Cymbalta at night, but I couldn't sleep. I might try the Wellbutrin at night. Unless, if we go to 300,I am more awake. I wonder how *much* dopamine Wellbutrin has?
Lois
Posted by Minnie-Haha on May 14, 2005, at 20:03:43
In reply to On Cymbalta 4 1/2 months now, posted by Minnie-Haha on April 29, 2005, at 16:03:08
> ... So on April 19, we traded the Wellbutrin XL for Wellbutrin SR 200mg. I have definitely seen a decrease in my appetite (I’ve lost two pounds) and an increase in my activity level. In fact, it might be a little too activating. I’m going to ride it out for 2-3 more weeks if I can, and if that doesn’t even out, I might ask my pdoc to drop it to 150mg...
So, I've been augmenting with the Wellbutrin SR for about a month now and it seems to be working A-OK. I think I've found a good balance of Trileptal / Cymbalta / Wellbutrin SR. I am continuing to go to Curves 3 days/week, plus I started Weight Watchers, and so far I've lost 5 of the 10 pounds I gained the first few months I was on Trilep and Cymbalta alone.
Mood: Euthymic. Sleep: OK. Cognitive: OK. Libido: OK. Appetite: OK. Motivation: OK. Pinch me!! Guess I'll sit tight here for awhile and see how long it holds.
This is the end of the thread.
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