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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by saturn on May 22, 2008, at 18:54:44
I am unable to tolerate SSRI's. I had severe anxiety and chest pain with Zoloft. I realize such a reaction is very rare, but nonetheless has discouraged me from ever trying an SSRI again. This reaction was not mania/mixed episode but rather severe panic and physiological response. I've also had a similiar response to stimulants.
Might there be any reason to consider Cymbalta? I am EXTREMELY med sensitive as mentioned above and am terrified of having another reaction like the one's mentioned above--my depression and GAD are actually much more tolerable.
Just curious if anyone has had any similiar experiences or input. Thanks...Peace...Saturn.
Posted by torachan on May 22, 2008, at 19:30:51
In reply to Cymbalta vs SSRI tolerability?, posted by saturn on May 22, 2008, at 18:54:44
Just my advice, but I tried Cymbalta a few weeks ago, and since I have anxiety like you, I thought I'd chime in.
Cymbalta, for me, was very stimulating/agitating, along the lines of Paxil though not quite as bad. I've read that Cymbalta compared to Effexor is tree times as strong in its effect on norepenephrine which could explain the high stimulation. For me, effexor was more tolerable. Take it for what it's worth.
Posted by torachan on May 22, 2008, at 19:32:11
In reply to Re: Cymbalta vs SSRI tolerability?, posted by torachan on May 22, 2008, at 19:30:51
^Meant to say three times as strong, not tree.
Posted by bleauberry on May 22, 2008, at 19:49:53
In reply to Cymbalta vs SSRI tolerability?, posted by saturn on May 22, 2008, at 18:54:44
There is no way to predict with cymbalta or any other med. Even though one, two, or three ssris produce massive anxiety with you, that does not mean that all of them will. At askapatient.com it is obvious that effexor gives some people viscious anxiety while it is very calming to other people. Go figure. Same with all these meds.
I am also very sensitive to meds and I could not tolerate more than 10mg of cymbalta (100 beads from inside the capsule mixed into applesauce). I did however get up to 30mg and even 60mg briefly when I was also on zyprexa 5mg. Zyprexa somehow blocked the anxiety stuff.
Most of the time, but not always, the med-induced anxiety will go away in time. For me, it took 3 months on paxil for things to get calm. It was a rough ride up until then.
Two strategies:
1) Start with super low doses (breaking pills, dividing contents of capsules) and stay at each dose increase 2 weeks before increasing, increase in small increments. For someone sensitive, the guidelines on the label or by an average doc are way over-the-top aggressive, in my opinion.
2) Use something to control the anxiety for some weeks while waiting for the med to take over. Something like low dose xanax or klonopin, with possible second teir choices of zyprexa or seroquel. Or sometimes remeron.Anyway, no way to predict how cymbalta will affect you. What it does to someone else is not indicative of what it will do to you.
Posted by Phillipa on May 22, 2008, at 21:17:23
In reply to Re: Cymbalta vs SSRI tolerability?, posted by bleauberry on May 22, 2008, at 19:49:53
Cymbalta at 60mg didn't bother me but then I was also on xanax I think. Paxil took three months too with xanax. And that was only l0mg of paxil. Phillipa
Posted by Jamal Spelling on May 23, 2008, at 6:03:09
In reply to Re: Cymbalta vs SSRI tolerability? » bleauberry, posted by Phillipa on May 22, 2008, at 21:17:23
I had no chest pain on Zoloft, whereas I sometimes have chest pain on Cymbalta. For me, Cymbalta is better than Zoloft.
Posted by zatar on May 24, 2008, at 18:07:00
In reply to Cymbalta vs SSRI tolerability?, posted by saturn on May 22, 2008, at 18:54:44
I just restarted Cymbalta and am titrating up from 1mg. At 1mg and 2mg, I felt more energized, lost my ravenous appetite and 10 pounds, but going up to 4mg left me feeling very anxious. I notice it most in the afternoons and am really avoiding driving at that time because I find it difficult to concentrate and I feel very spacey, so I lowered the dose today to 3mg and will see how that goes.
I, too, cannot tolerate SSRIs. My Pdoc insists that at this low dose, Cymbalta's SSRI portion does not kick in. So I'm not sure whether this is NOT true and I am getting SSRI side effects, or maybe it's the NERI side effects. Caffeine and chocolate make me anxious and disturb sleep.
The confounding factor is that I also switched from low dose doxepin for sleep to trazodone at the same time. I'm also getting lots of stomach upset. Doxepin is said to work on VIPS (vasoactive intestinal peptides) and have a quinidine like effect to stablize heart rhythm, so maybe my increased feeling of heart palpitations is actually from going off the doxepin and not the Cymbalta. Another reason to alter medications one at a time...I know better, but???
The thing NOT to do is to start at a usual dose of Cymbalta. I was convinced to do that a couple of years ago and had severe anxiety, agitation and akathisia at 60mg. I dosed down to 5mg and did well there until another doctor convinced me to go off the Cymbalta to try amitriptyline. This current trial is not going as well, but other things have changed in my health.
I agree with the above poster - start very low and go slow. Only a trial will tell if it's right for you.
Good luck!
-zatar
Posted by crittercuddler on December 14, 2008, at 17:49:28
In reply to Re: Cymbalta vs SSRI tolerability?, posted by zatar on May 24, 2008, at 18:07:00
zatar,
I just read your post from May and I was so happy to find someone else who has adverse reactions to even tiny doses of SSRIs. I have been struggling with this for 3 years now myself.
I was wondering if you ended up getting stable on something? I would love to hear from you about what worked for you and in general would appreciate any advice you want to give.
Please take a look at my posting on the Medication board, under crittercuddler. It will be on down towards the bottom as I just joined a few days ago.
Thanks so much
-michelle
Posted by Lindy Star on December 19, 2008, at 11:40:44
In reply to Re: Cymbalta vs SSRI tolerability?, posted by crittercuddler on December 14, 2008, at 17:49:28
If you can't take SSRI's what about a dopamine or norepinephrine re-uptake inhibitor or agonist? (i.e. Abilify, or Effexor {I think})
This is the end of the thread.
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