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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 flmm on June 7, 2005, at 21:27:15
I read it effects serotonin more at higher doses only. Oppisite Effexor. Is this true?
Posted by Phillipa on June 7, 2005, at 23:36:43
In reply to cymbalta effect more norepiniphrine at low doses/, posted by flmm on June 7, 2005, at 21:27:15
That's interesting. Why would this be so? Fondly, Phillipa
Posted by barbaracat on June 9, 2005, at 13:34:29
In reply to cymbalta effect more norepiniphrine at low doses/, posted by flmm on June 7, 2005, at 21:27:15
Many ADs seem to morph into different drugs as you change doses. This was certainly true with Remeron which only at higher doses does the NE kick in.
One of the hallmarks of Cymbalta, which I'm still taking very successfully, is that the NE kicks in much more quickly (immediately in my experience) than usual. The serotonin takes the typical 3-4 weeks, but that quick acting NE is what makes it 'novel'.
I'm still only able to take 6mg which is 60 pellets out of the capsule. I've tried taking a whole 30mg capsule quite a few times and almost went over the edge from effects that my pdoc tells me are typical of too much NE. I'm probably ultra senstive to NE with my anxiety disorder and would like to get to a higher serotonin level but can't tolerate pushing the dose, and where it's at works fine.
What is interesting is that this is switched from other ADs which affect NE only at higher levels instead of vice versa with Cymbalta.
> I read it effects serotonin more at higher doses only. Oppisite Effexor. Is this true?
Posted by Phillipa on June 9, 2005, at 17:44:15
In reply to Re: cymbalta effect more norepiniphrine at low doses/ » flmm, posted by barbaracat on June 9, 2005, at 13:34:29
So if I could tolerate Cymbalta at 60mg with no side effects does this mean I need more norepenephrine? Fondly, Phillipa
Posted by barbaracat on June 9, 2005, at 21:16:43
In reply to Re: cymbalta effect more norepiniphrine at low doses/ » barbaracat, posted by Phillipa on June 9, 2005, at 17:44:15
I don't know, Phillipa. Are you bipolar? I don't remember. It seems that the majority of those who can tolerate higher doses of Cym are unipolar and it even makes them sleepy. My suspicipion is that there's something about bipolars that react with NE and maybe it further differentiates between bipolar I vs. II. Who knows? I can only speculate based on how it affected me and a few other bipolars who went down the same road. With my tendency towards anxiety, panic disorder and stress, extra NE might be an overdose to my already adrenaline charged body.
It amazes me, those who go to 60mg and beyond. Our chemistries are so different. How do you do with benzos? I can take quite a high dose, many times normal, and not feel anything.
My armchair diagnosis is that I believe it comes down to how our individual liver enzymes clear out the drugs. Bipolars might perhaps have a genetic malfunction of certain enzymes in common that result in adrenaline type compounds taking longer to clear and circulating longer, making us more susceptible that way.
So, for you, it may not be that you need more NE, as much as your cytochrome enzyme system is working just fine and your'e clearing the drug as you're supposed to.
> So if I could tolerate Cymbalta at 60mg with no side effects does this mean I need more norepenephrine? Fondly, Phillipa
Posted by Phillipa on June 9, 2005, at 21:28:34
In reply to Re: cymbalta effect more norepiniphrine at low doses/ » Phillipa, posted by barbaracat on June 9, 2005, at 21:16:43
I can also tolerate benzos at extremely high doses. Well to me they're high doses. I'm taking l5mg of valium. Took 20mg of valium the other night because I couldn't sleep and as an experiment. I slept better but not great. I'm now starting luvox. Took 25mg last night. A few years this was prescribed for me and I ended up at 250mg with no side effects. Along with 4-5mg of ativan and chloral hydrate for sleep. Felt good with no side effects. Then the stupid pdoc took me off of it to try celexa when it first came out. That knocked me on my ear. But at the same time I was dx'd with lymes disease. So I could have been sick. Then when I was given luvox again I got up to l50mg after several tries. Felt good for two weeks then crashed. Since then could only tolerate l2.5mg. Time goes by Menopause. my chemistry must have changed. Less anxiety, less ability to sleep, and awaken earlier. Now the luvox and other meds don't seem to effect me. Fondly, Phillipa
Posted by barbaracat on June 9, 2005, at 21:45:07
In reply to Re: cymbalta effect more norepiniphrine at low doses/ » barbaracat, posted by Phillipa on June 9, 2005, at 21:28:34
Sounds like you're a challenging case. My pdocs have thrown up their hands with me. But finally, I can say I'm on my way to being cured.
Lyme disease, eh? This may be a big clue. Have you followed up on this? I can trace my descent into fibromyalgia and the bad physical symptoms from 1985 when I came down with mycoplasma pneumonia. These critters are now being implicated in creating a neurotoxic condition that eventually will require long-term antibiotic therapy. Ugh, there go the friendly gut flora.
Also, when I hit menopause, everything hit the wall. Getting the right hormonal therapy helped. There's so much involved with this, so many physical pathways to sleuth out and I haven't found one pdoc who ventures any farther than the head.
Some day, they'll be able to put a little electric hat on us and see all the broken parts on a computer screen. But they won't be able to to see how the spirit and soul have been so hurt.
It's very interesting that you also have a tolerance to benzo type meds. I'm finding this more and more and it goes along with the anxiety, insomnia, etc., that exacerbates the main mood condition.
Are you taking a mood stabilizer? I get on a soap box about this subject because it's too frequent that ADs don't work as well without a MS whether you're bipolar or not. - Barbara
> I can also tolerate benzos at extremely high doses. Well to me they're high doses. I'm taking l5mg of valium. Took 20mg of valium the other night because I couldn't sleep and as an experiment. I slept better but not great. I'm now starting luvox. Took 25mg last night. A few years this was prescribed for me and I ended up at 250mg with no side effects. Along with 4-5mg of ativan and chloral hydrate for sleep. Felt good with no side effects. Then the stupid pdoc took me off of it to try celexa when it first came out. That knocked me on my ear. But at the same time I was dx'd with lymes disease. So I could have been sick. Then when I was given luvox again I got up to l50mg after several tries. Felt good for two weeks then crashed. Since then could only tolerate l2.5mg. Time goes by Menopause. my chemistry must have changed. Less anxiety, less ability to sleep, and awaken earlier. Now the luvox and other meds don't seem to effect me. Fondly, Phillipa
Posted by Phillipa on June 9, 2005, at 21:52:34
In reply to Re: cymbalta effect more norepiniphrine at low doses/ » Phillipa, posted by barbaracat on June 9, 2005, at 21:45:07
Well, I do have a half bottle of trileptal l5mg which my old pdoc Rx'd for "mood and sleep". When I switched pdoc's he discontinued it and put me on the cymbalta and klonopin. I could add l50mg of trileptal to the valium l5mg and luvox 25mg and see what happens. What do you think? Fondly, Phillipa. PS I might add that I gave my husband l50mg of trileptal one night because he couldn't sleep and he couldn't wake up the whole next day. As a matter of fact i was so scared i started a Thread on it.
Posted by barbaracat on June 9, 2005, at 21:58:46
In reply to Re: cymbalta effect more norepiniphrine at low doses/ » barbaracat, posted by Phillipa on June 9, 2005, at 21:52:34
Trileptal, as you know, is used as a mood stabilizer in bipolar. I doubt your doc would prescribe it for anything else. I've never tried it, as lithium works well for me, but I have a friend who has had better luck with trileptal than all the other MSs. It sounds like a discussion with your pdoc is in order, cause it's pretty potent stuff and would be a wise thing to monitor.
I always recommend this site as a gold mine of information. You can troll it for weeks and find out all kinds of stuff about bipolar and related conditions:
www.psycheducation.org
> Well, I do have a half bottle of trileptal l5mg which my old pdoc Rx'd for "mood and sleep". When I switched pdoc's he discontinued it and put me on the cymbalta and klonopin. I could add l50mg of trileptal to the valium l5mg and luvox 25mg and see what happens. What do you think? Fondly, Phillipa. PS I might add that I gave my husband l50mg of trileptal one night because he couldn't sleep and he couldn't wake up the whole next day. As a matter of fact i was so scared i started a Thread on it.
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