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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by b2chica on June 12, 2012, at 15:40:27
i'm on
pristiq
(adderall, perphenazine, and gabapentin(prn) xanax(prn))could i try adding on cymbalta even though its another snri? i typically have bad results with ssri so please dont suggest.
and yes tried pristiq at 100 nothing.please tell me if this would be a possibility?
i finally got the balls to write a txt to pdoc. i truly dont want to talk to him. i'm afraid he'll laugh off my symptoms, or tell me their all in my head...all psychological.
maybe it is. it probably is. but i've tried all the normal things. i swear i'm getting worse.
i dont want to live like this. pretending forever. i cant feel anything. i laugh when i'm supposed to, i smile when i'm supposed to, but i feel nothing. i'm a void.(Scott i'd like to hear your thoughts on this too please)
b2c.
Posted by Phillipa on June 12, 2012, at 16:59:14
In reply to cymbalta and another SNRI, posted by b2chica on June 12, 2012, at 15:40:27
B2Chica I don't think you can combine the two. I do hope Scott reads and answers your post. Are you still seeing T? Phillipa
Posted by SLS on June 12, 2012, at 19:15:31
In reply to cymbalta and another SNRI, posted by b2chica on June 12, 2012, at 15:40:27
> i'm on
> pristiq
> (adderall, perphenazine, and gabapentin(prn) xanax(prn))
>
> could i try adding on cymbalta even though its another snri? i typically have bad results with ssri so please dont suggest.
> and yes tried pristiq at 100 nothing.What is your rationale for choosing to combine these two drugs?
> please tell me if this would be a possibility?
I would consider adding either Wellbutrin or nortriptyline first. Maybe Remeron would also help. I cannot guarantee that adding Cymbalta would not work, but I think the other drugs may be more complementary with regard to mechanisms of action. That being said, Pristiq and Cymbalta are, indeed, different drugs, despite their having overlapping properties. Perhaps combining them would help. There may be important properties of these drugs that do not overlap. The obvious concern regarding the combination of two drugs that are serotonin reuptake inhibitors is that of precipitating serotonin syndrome.
> i'm afraid he'll laugh off my symptoms, or tell me their all in my head...all psychological.
> i dont want to live like this. pretending forever. i cant feel anything. i laugh when i'm supposed to, i smile when i'm supposed to, but i feel nothing. i'm a void.
It is obvious to me that you are a hard-worker and unwilling to capitulate at this point. However, your affect is flat. You might suffer from anhedonia. I don't see dysphoria in your description. Being void of feelings can be a psychological reaction to avoid the pain of dealing with emotional issues. However, it seems more likely to me that the presence of anhedonia argues for your having an illness with a more prominent biological component.
Which atypical antipsychotics have you tried so far? What were the results?
- Scott
Posted by b2chica on June 13, 2012, at 7:52:35
In reply to Re: cymbalta and another SNRI » b2chica, posted by SLS on June 12, 2012, at 19:15:31
Hi.
i feel that pristiq is pooping out and going to 100 does nothing for me. i thought that adding a similar AD (that worked in the past) would be complimentary and maybe have some nice synergistic effect. if used at low dose.i've been on wellbutrin in the past worked wonderful for a year then pooped out. tried it again and again with no luck (two types of generic and real deal to no avail).
also been on remeron. not tried nortiptyline.i've been on abilify (bad anger reaction)
zyprexa normally worked in the past, last time didn't work but used generic?? unsure
used risperdal, no positive effect
on perphenazine (low dose)
and i can't think right now, probably others?************************
i finally got the nerve and txt'd pdoc yesterday, was feeling so terrible. he called last night. we talked for a while (of course i had already 4 beers in me so i was quite honest with him). he said it was hard over the phone but he thinks true depressive episode rather than psychological, but is more than willing to try the cymbalta (he said he was considering thatlolsure right). he said we'd really have to be careful though. he also seems to think that the perphenazine is the culprit so he wants me to stop the perphenazine in the am only. and txt or call thurs how i'm feeling. he's going to see if his office has samples of cymbalta. we'll talk more thursday. or he'll try to get me in friday.thanks for your help Scott.
ps. i was thinking nortriptyline in the past but i dont want to gain anymore weight either if i can help it, so i will try the cymbalta first. besides, in my state of mind right now i dont think a TCA is a really good idea for me. i have so ideation going on and its a bit weird and scary to me at times.thanks again i always appreciate your insight.
b2c.
Posted by b2chica on June 13, 2012, at 8:30:49
In reply to Re: cymbalta and another SNRI » b2chica, posted by SLS on June 12, 2012, at 19:15:31
geodon. low dose didnt work for severe depression, when increased i became psychotic.
Posted by bleauberry on June 14, 2012, at 15:47:03
In reply to cymbalta and another SNRI, posted by b2chica on June 12, 2012, at 15:40:27
The mix you suggested doesn't sound good to me. I could spend some time explaining why.
Here are similar ones that HAVE already been done with good results: (using effexor not pristiq, but they are similar enough I think to make inferences).
Effexor + Savella
Cymbalta + Savella
Effexor + Wellbutrin + Savella
Effexor + WellbutrinAnd as SLS mentioned, Nortriptyline is a strong worthy player too. I'm not a big fan of wellbutrin so my biased preference would be savella first try, nortriptyline second try, wellbutrin last.
Posted by b2chica on June 15, 2012, at 10:06:44
In reply to Re: cymbalta and another SNRI, posted by bleauberry on June 14, 2012, at 15:47:03
not sure what to do right now.
i stopped perphenazine in the am. my anxiety sky-rocketed and is back to almost out of control, i only see it getting worse.
but my anhedonia is much better. i'mstill not out of the water mood wise, but much better than before.
kind of embarrasing but i'm having some hygiene problems right now. cant seem to take a shower. i absolutely cant/Dont want to take one.its like i'm afraid. or too exhausted. been 6 days. i know TMI, but still i attribute this to my mood.whats hard is on the one hand i have extreme anxious energy, like shaky knee, figiting, very low concentration, cant sit still.
on the other hand, i'm still exhausted, taking deep breaths, want to just lay down.i dont know how long i can keep up this dual action stuff. its physically and emotionally confusing and taxing.
Posted by b2chica on June 15, 2012, at 10:07:11
In reply to Re: cymbalta and another SNRI, posted by bleauberry on June 14, 2012, at 15:47:03
would savella help with anxiety at all?
Posted by Zyprexa on June 16, 2012, at 1:01:55
In reply to Re: cymbalta and another SNRI, posted by b2chica on June 15, 2012, at 10:06:44
Why did you stop the perphenazine? Its good to know that it was helping your anxiety a lot. I've never taken mine with out some dose of zyprexa at the same time, so I wasn't sure. This is why I think you would better respond to a higher dose of perphenazine. I wonder if it could replace your zyprexa.
Posted by bleauberry on June 16, 2012, at 6:15:35
In reply to Re: savella, posted by b2chica on June 15, 2012, at 10:07:11
> would savella help with anxiety at all?
Likely yes and no.
At the start for a few days to a week maybe, anxiety would maybe go up. The feedback loops kick in and then the calming starts. For me Savella was really good at anti anxiety, even though I was terrified it was going to make it worse since it hits norepinephrine pretty good. The first few days I was wired, lousy sleep, nervous, shakey....and that all went away quickly.
Most people I think dose savella too high. Normal doses in my opinion are too aggressive....they cause people to fail and abandon the med without a good trial. This is a med that does it work over months, and so a strategy is needed to stay in the game that long, which to me means using tolerable doses. To me that was 6mg a day (half the smallest dose). And that mere little stupid 6mg worked better than ECT and a backpack full of other meds! Had I tried to stay on regular doses, forget it, it would have been a failure and I would probably be calling it poison. I think this applies to a lot of meds....it isn't always the med itself that is a problem but the dose.
Other people here have tried savella and I recall a couple of them dropped it because the anxiety stuff was too much.....their doses were too high too fast and it's just as simple as that.
No single med helped me more during zyprexa withdrawals or after ECT failure than savella.
Posted by B2chica on June 18, 2012, at 8:01:30
In reply to Re: savella, posted by bleauberry on June 16, 2012, at 6:15:35
great to know about the svella.
things are looking up right now from only stopping the morning perphenazine.
thanks so much bl.
Posted by B2chica on June 18, 2012, at 8:04:25
In reply to perphenazine » b2chica, posted by Zyprexa on June 16, 2012, at 1:01:55
my pdoc actually thought the perph was causing anhedonia, so he wanted me to stop that for a few days just to see. i think he was right. i'm feeling better. my anxiety is high again but i'm somewhat controlling it with gabapentin, and not too high dose of that either.
things are looking good right now. i want to give it a couple weeks to really see.
i'm kinda glad cuz i was a little scared to add cymbalta after reading about seratonin syndrome.
Thanks as always my friend Z.
B2c.
Posted by phidippus on June 19, 2012, at 17:48:12
In reply to cymbalta and another SNRI, posted by b2chica on June 12, 2012, at 15:40:27
Anhedonia is hard to treat. I would recommend a TCA like Amitryptaline along with Requip, Mirapex or Wellbuttrin.
Eric
Posted by creepy on June 25, 2012, at 9:25:11
In reply to cymbalta and another SNRI, posted by b2chica on June 12, 2012, at 15:40:27
docs wont usually do polypharmacy (doubling up on meds that work on the same system).
SSRIs can cause apathy and emotional numbing too.
What about adding something like wellbutrin?
Posted by phidippus on June 25, 2012, at 16:21:21
In reply to Re: cymbalta and another SNRI, posted by creepy on June 25, 2012, at 9:25:11
That's not true. Though some drugs work on the same system, their mechanism of action is different, say Luvox and Prozac.
Eric
Posted by creepy on June 26, 2012, at 11:03:15
In reply to Re: cymbalta and another SNRI » creepy, posted by phidippus on June 25, 2012, at 16:21:21
You would have to find a very unique doc to get a prescription for two serotonergic drugs, regardless of the way they work.
Everyone is so scared of liability, the patient is the one that suffers.
This is the end of the thread.
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