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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 dove on September 27, 2004, at 9:10:28
Hey there everyone!
I have been somewhat stable for the last year and a half on a med combo of Effexor 225 mg., Prozac 20 mg., and Mirtazapine 45 mg. The original med combo also included Adderal and Klonopin, but I went off those due to getting pregnant (I had the baby this past March).
Now, they're talking about weaning me off all those meds in favor of one, Lexapro. How on earth is Lexapro going to cover what my other combo did? I am very leery of this switch, as it has taken me years to find anything that even touches my depression.
The other med being talked about is Cymbalta, but they want to try Lexapro first. Should I just say "NO!" ;-)
Is Cymbalta similar to the combo of Effexor and Mirtazapine? Would I be able to take one med instead of two? I would love to get rid of the Mirtazapine if at all possible (I've had weight gain and my legs kick all night long).
Any thoughts or advice, thanks in advance!!!
dove
Posted by Sad Panda on September 27, 2004, at 10:25:18
In reply to Eff/Prozac/Mirtaz switch to Lexapro?, posted by dove on September 27, 2004, at 9:10:28
> Hey there everyone!
>
> I have been somewhat stable for the last year and a half on a med combo of Effexor 225 mg., Prozac 20 mg., and Mirtazapine 45 mg. The original med combo also included Adderal and Klonopin, but I went off those due to getting pregnant (I had the baby this past March).
>
> Now, they're talking about weaning me off all those meds in favor of one, Lexapro. How on earth is Lexapro going to cover what my other combo did? I am very leery of this switch, as it has taken me years to find anything that even touches my depression.
>
> The other med being talked about is Cymbalta, but they want to try Lexapro first. Should I just say "NO!" ;-)
>
> Is Cymbalta similar to the combo of Effexor and Mirtazapine? Would I be able to take one med instead of two? I would love to get rid of the Mirtazapine if at all possible (I've had weight gain and my legs kick all night long).
>
> Any thoughts or advice, thanks in advance!!!
>
> dove
>
>Hi Dove,
Is there a problem with your current meds that is forcing you to change away from Effexor + Prozac? Have you tried not taking Mirtzapine? I have had that feeling in my legs from Mirtazapine & found that it went away at lower doses. I use to use it for sleep & it also covers a few side effects caused by Effexor.
Cheers,
Paul.
Posted by jrbecker on September 27, 2004, at 14:43:34
In reply to Re: Eff/Prozac/Mirtaz switch to Lexapro? » dove, posted by Sad Panda on September 27, 2004, at 10:25:18
> > Hey there everyone!
> >
> > I have been somewhat stable for the last year and a half on a med combo of Effexor 225 mg., Prozac 20 mg., and Mirtazapine 45 mg. The original med combo also included Adderal and Klonopin, but I went off those due to getting pregnant (I had the baby this past March).
> >
> > Now, they're talking about weaning me off all those meds in favor of one, Lexapro. How on earth is Lexapro going to cover what my other combo did? I am very leery of this switch, as it has taken me years to find anything that even touches my depression.
> >
> > The other med being talked about is Cymbalta, but they want to try Lexapro first. Should I just say "NO!" ;-)
> >
> > Is Cymbalta similar to the combo of Effexor and Mirtazapine? Would I be able to take one med instead of two? I would love to get rid of the Mirtazapine if at all possible (I've had weight gain and my legs kick all night long).
> >
> > Any thoughts or advice, thanks in advance!!!
> >
> > dove
> >
> >
>
> Hi Dove,
>
> Is there a problem with your current meds that is forcing you to change away from Effexor + Prozac? Have you tried not taking Mirtzapine? I have had that feeling in my legs from Mirtazapine & found that it went away at lower doses. I use to use it for sleep & it also covers a few side effects caused by Effexor.
>
> Cheers,
> Paul.
>
>
>
I think you're right. You will most likely not see the same benefit from Lexapro monotherapuetically. And I think that's pretty dangerous that your doc recommended this. However, as Paul mentioned, you might want to give us a little more info on why the doc thought the med changeup would be good.But off the top of my head, if I was to foresee a plan to simplify your med cocktail WITHOUT substituting for efficacy, I would shelve the prozac and effexor for a trial of cymbalta. My instincts says that I would keep on the remeron for now, but maybe readjust to 15 or 30mg for a while. There might be a little bit of a noradrenergic reaction b/t the cymbalta and remeron, but I really doubt it since you're already on a high dose of effexor.
I know you didn't want to hear this, since you'd like to get off the remeron. but I think that's probably the next thing to tackle if you still feel you're doing alright. Since I've been in your situation many a time before, I just want to remind you of not being too hasty in your drug changeups. Go slow.
this just my own subjective insight.
good luck
Posted by dove on September 28, 2004, at 9:54:17
In reply to Re: Eff/Prozac/Mirtaz switch to Lexapro?, posted by jrbecker on September 27, 2004, at 14:43:34
> Is there a problem with your current meds that is forcing you to change away from Effexor + Prozac? Have you tried not taking Mirtzapine? I have had that feeling in my legs from Mirtazapine & found that it went away at lower doses. I use to use it for sleep & it also covers a few side effects caused by Effexor.
>
>
Essentially, they merely want to simplify my med regimen, though I've not complained or asked for this service. They "say" they want to be cautious because I'm still in the danger zone for post-partum compounded depression, which I've greatly struggled with in the past.The problems with Mirtazapine begin with the lower dosages causing excessive sleepiness and *more* hunger, and consequently more weight gain. The higher dosages culminating in the insanely vigorous leg kicking, which is driving me and my partner beyond mere distraction.
Without Mirtazapine, the Effexor/Prozac combo feels like a wimpy SSRI effort, definitely missing its "oomph!".
Lexapro just doesn't look good to me at all. I would not feel comfortable switching that for the Prozac and Effexor, especially considering the fact that I'm on a fairly high dosage of Effexor.
Thanks for the responses!!!dove
Posted by dove on September 28, 2004, at 10:17:37
In reply to Re: Eff/Prozac/Mirtaz switch to Lexapro?, posted by jrbecker on September 27, 2004, at 14:43:34
>
> There might be a little bit of a noradrenergic reaction b/t the cymbalta and remeron, but I really doubt it since you're already on a high dose of effexor.
>Which is exactly why I need that Remeron (Mirtazapine). It interacts with the Effexor/Prozac combo and gives those two a little more bang.
> I know you didn't want to hear this, since you'd like to get off the remeron. but I think that's probably the next thing to tackle if you still feel you're doing alright. Since I've been in your situation many a time before, I just want to remind you of not being too hasty in your drug changeups. Go slow.
>
So, even if I were to initiate a Cymbalta trial, I would probably still require Remeron.How similar is Cymbalta to Effexor? Is Cymbalta broader acting, more narrow? I don't know enough yet to make an informed decision.
Is there any one med that is comparable to the combo of Effexor/Remeron?
Or for that matter, any med that is comparable to Remeron in its ability to potentiate Effexor and/or Cymbalta?
Thanks for your time, it is much appreciated!
dove
Posted by SLS on September 28, 2004, at 10:58:40
In reply to Re: Eff/Prozac/Mirtaz switch to Lexapro?, posted by jrbecker on September 27, 2004, at 14:43:34
Hi JB.
Sorry for the interruption.
I was curious to know how you were doing with Cymbalta. What dosage are you at?
Also, if you wouldn't mind, should you become manic (which I hope doesn't happen), can I have the extra juice. Cymbalta isn't really helping me anymore.
:-(
- Scott
Posted by SLS on September 28, 2004, at 10:59:28
In reply to Eff/Prozac/Mirtaz switch to Lexapro?, posted by dove on September 27, 2004, at 9:10:28
Hi Dove.
:-)
- Scott
Posted by jrbecker on September 28, 2004, at 15:28:59
In reply to Re: Eff/Prozac/Mirtaz switch to Lexapro? » jrbecker, posted by SLS on September 28, 2004, at 10:58:40
> Hi JB.
>
> Sorry for the interruption.
>
> I was curious to know how you were doing with Cymbalta. What dosage are you at?
>
> Also, if you wouldn't mind, should you become manic (which I hope doesn't happen), can I have the extra juice. Cymbalta isn't really helping me anymore.
>
> :-(
>
>
> - Scott
Scott, buddy,Sorry you're not fairing well on duloxetine so far. But it sounds like at least has had a slight benefit for you thus far.
At over 5 weeks, I'm doing pretty well in terms of the actual depression and anxiety. I rarely catch myself ruminating. I'm more social and more activem. Even better, my energy is still pretty good. My main complaints are still problems with attention/focus, motivation, slight sedation. I don't plan on going up any higher at this point, but actually might even try out 20mg daily at some point.
Have you and your doc considered going up to 80mg?
Are you thinking about adding back in a TCA?
Posted by SLS on September 28, 2004, at 16:28:12
In reply to Re: Eff/Prozac/Mirtaz switch to Lexapro? » SLS, posted by jrbecker on September 28, 2004, at 15:28:59
Hi JB.
I'm glad you are feeling better. I hope you experience continued improvement and on to remission.
> Have you and your doc considered going up to 80mg?
I think he will consider it at my next visit in two weeks. I think the Lilly reps have disuaded him from doing it so soon. I get the feeling that 80mg will be the recommended dose for SUI, though.
> Are you thinking about adding back in a TCA?
That is an interesting suggestion. Hmm.
Thanks.
- Scott
This is the end of the thread.
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