Effexor -> Cymbalta - Information/Anecdotes?
TehDizzyBroad
long time, so bear with me here. Looks I'm going to be longwinded,
getting all the details right!
27 year old female. I have been suffering from depression (clinical
moderate to clinical severe) for a decade now; much of that time I
spent unmedicatd, for any number of reasons. Several years ago, I also
developed SAD which kept me reclusive for two+ years. For the most
part, I overcame the SAD by what I can only describe as self-applied
CBT - forcing myself back into the workforce to overcome my issues
with people. This worked a treat, for the most part, but I did not
understand at the time that contributed little to the root of the
problem - the depression - for the longterm. I was keeping my head
above water, functioning enough to survive and support my family, but
happiness was a vague memory, and I was highly emotional and stressful;
I made it through each day by 'faking' it in public. A bad day had me
hiding away from my family, suffering through crying jags, unbearably
tense; good days I felt tired, achy, somewhat worthless, guilt-ridden,
but at least clear-headed. Insomnia was also a major factor throughout
the years - sometimes not being able to fall asleep, sometimes waking
up several times at night, but for the past few years it seemed
somewhat cyclic, a few months of problems followed by a few months of
brief, but blissfully uninterrupted sleep.
Over the summer, I felt myself sliding back downwards into a deeper
depression, and with the availability of a health care plan, finally
went to see my psych (clinical nurse practicioner). Even having gone
to him on a 'good' day, he saw clearly that there was a problem, and
prescribed Effexor XR on the spot. This surprised me after only a 40
minute consultation, but at that point I was desperate. I titrated up
slowly from 37.5 - 150mg taken once daily in the morning, experiencing
only minor side effects (dizziness, foggy-headedness, apathy),
especially the day or two after I would up my dosage. Most of them
went away after the first several days on 75mg, and stayed away at 150,
except for a lowered libido, anorgasmia, and dry mouth.
It's been another six weeks on 150mg, and I can't remember ever feeling
this good. Even with the minor headaches and body aches that I believe
can be attributed to the Effexor, the good far outweighs the bad. I am
no longer an emotional wreck, to put it simply. However, I broached
the subject of the side effects with the psych - he was especially
concerned about the dry mouth; for me, at least (especially sleeping
with a fishtank almost at the foot of my bed), it goes: dry mouth ->
higher fluid intake -> full bladder -> interrupted sleep to travel up a
flight of stairs and fully across the house to pee. Already having
sleep problems, this - in a word - sucked. Coupled with sexual
problems? Maybe something could change...
After discussing sedatives for nighttime, and disregarding it because
of the very real possibility of wetting the bed, he recommended
switching the SSNRI from Effexor XR to Cymbalta - starting with 30mg of
Cymbalta, then going up to 60mg if needed after a week, but no more
than that. Cymbalta, he said, shows a lower prevalence of side-effects
than Effexor, with less severity as well.
Now to the questions. Are you still reading?
Has anyone switched from Effexor to Cymbalta, especially for similar
reasons? If so, what were your experiences?
After discussing withdrawl syndrome (I brought it up, not him), he
reassured me that with the switch - no cross tapering, just straight
from one to the other - if there were any withdrawl effects at all,
they would be mild and flu-like because both medications are SSNRI's.
Is this true?
I still have a few days to decide - he told me to do my research, and
if I did not feel comfortable with the switch, just to bring the
samples back to him. If I decided to, I would start probably Saturday,
so to interfere as little as possible with my work schedule.
Any guidance, information or experiences you can offer would be greatly
appreciated!
Nom dePlume
"TehDizzyBroad" <adel...@gmail.com> wrote in message
news:1169666139.8...@l53g2000cwa.googlegroups.com...
> First post to this group-- first post to *any* Usenet group in a
> long,
> long time, so bear with me here. Looks I'm going to be longwinded,
> getting all the details right!
[Deletia]
> After discussing sedatives for nighttime, and disregarding it
> because
> of the very real possibility of wetting the bed, he recommended
> switching the SSNRI from Effexor XR to Cymbalta - starting with 30mg
> of
> Cymbalta, then going up to 60mg if needed after a week, but no more
> than that. Cymbalta, he said, shows a lower prevalence of
> side-effects
> than Effexor, with less severity as well.
>
> Now to the questions. Are you still reading?
>
> Has anyone switched from Effexor to Cymbalta, especially for similar
> reasons? If so, what were your experiences?
>
> After discussing withdrawl syndrome (I brought it up, not him), he
> reassured me that with the switch - no cross tapering, just straight
> from one to the other - if there were any withdrawl effects at all,
> they would be mild and flu-like because both medications are
> SSNRI's.
> Is this true?
I can't speak from experience, but I would suspect he is correct. The
two medications are in the same category (it's a small category), so
it seems likely that withdrawal effects would be minimized.
> I still have a few days to decide - he told me to do my research,
> and
> if I did not feel comfortable with the switch, just to bring the
> samples back to him. If I decided to, I would start probably
> Saturday,
> so to interfere as little as possible with my work schedule.
>
> Any guidance, information or experiences you can offer would be
> greatly
> appreciated!
I hope this helps, and I hope the medication helps.
--
Nom dePlume, Ph.D.
Why, yes, in fact, I am a rocket scientist.
Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000/
=====
TehDizzyBroad
It is helpful, thanks - any little bit of reassurance from people
in-the-know makes me a little more confident about making the switch.
The only thing I guess that concerns me now is if Cymbalta isn't right
for me... but Effexor is no longer effective because of the switch.
On the upside, it looks like I've got an office buddy who's making a
med switch to Cymbalta too, so I've got a bit od a support system
kicking here, too!
On Jan 24, 11:20 pm, "Nom dePlume" <nomdeplume1000-at-yahoo.com> wrote:
> "TehDizzyBroad" <adelw...@gmail.com> wrote in messagenews:1169666139.8...@l53g2000cwa.googlegroups.com...
>
> > First post to this group-- first post to *any* Usenet group in a
> > long,
> > long time, so bear with me here. Looks I'm going to be longwinded,
> > getting all the details right![Deletia]
>
>
>
> > After discussing sedatives for nighttime, and disregarding it
> > because
> > of the very real possibility of wetting the bed, he recommended
> > switching the SSNRI from Effexor XR to Cymbalta - starting with 30mg
> > of
> > Cymbalta, then going up to 60mg if needed after a week, but no more
> > than that. Cymbalta, he said, shows a lower prevalence of
> > side-effects
> > than Effexor, with less severity as well.
>
> > Now to the questions. Are you still reading?
>
> > Has anyone switched from Effexor to Cymbalta, especially for similar
> > reasons? If so, what were your experiences?
>
> > After discussing withdrawl syndrome (I brought it up, not him), he
> > reassured me that with the switch - no cross tapering, just straight
> > from one to the other - if there were any withdrawl effects at all,
> > they would be mild and flu-like because both medications are
> > SSNRI's.
> > Is this true?I can't speak from experience, but I would suspect he is correct. The
> two medications are in the same category (it's a small category), so
> it seems likely that withdrawal effects would be minimized.
>
> > I still have a few days to decide - he told me to do my research,
> > and
> > if I did not feel comfortable with the switch, just to bring the
> > samples back to him. If I decided to, I would start probably
> > Saturday,
> > so to interfere as little as possible with my work schedule.
>
> > Any guidance, information or experiences you can offer would be
> > greatly
> > appreciated!I hope this helps, and I hope the medication helps.
Larry Hoover
"Nom dePlume" <nomdeplume1000-at-yahoo.com> wrote in message
news:ep9b4...@news3.newsguy.com...
>
>
> "TehDizzyBroad" <adel...@gmail.com> wrote in message
> news:1169666139.8...@l53g2000cwa.googlegroups.com...
>> reassured me that with the switch - no cross tapering, just straight
>> from one to the other - if there were any withdrawl effects at all,
>> they would be mild and flu-like because both medications are SSNRI's.
>> Is this true?
>
> I can't speak from experience, but I would suspect he is correct. The two
> medications are in the same category (it's a small category), so it seems likely
> that withdrawal effects would be minimized.
After hearing about this on another board, I checked it out. Did you know that Paxil
(paroxetine) has far higher norepinephrine transporter inhibition than does Effexor
(venlafaxine)? Lower numbers are stronger inhibitors. From:
http://kidb.cwru.edu/pdsp.php
Paroxetine Ki (Inhibition Constant; nM)
norepinephrine transporter 45
dopamine transporter 963
serotonin transporter 0.34
Venlafaxine Ki (nM)
norepinephrine transporter 1420
dopamine transporter 3070
serotonin transporter 102
Of course, there are other considerations, not the least of which is dose. But how
did Paxil come to be known as a selective serotonin inhibitor?
Lar
TehDizzyBroad
On Jan 25, 6:08 pm, "Larry Hoover" <larryhoo...@sympatico.ca> wrote:
> "Nom dePlume" <nomdeplume1000-at-yahoo.com> wrote in messagenews:ep9b4...@news3.newsguy.com...
>
>
>
> > "TehDizzyBroad" <adelw...@gmail.com> wrote in message
> >news:1169666139.8...@l53g2000cwa.googlegroups.com...
> >> After discussing withdrawl syndrome (I brought it up, not him), he
> >> reassured me that with the switch - no cross tapering, just straight
> >> from one to the other - if there were any withdrawl effects at all,
> >> they would be mild and flu-like because both medications are SSNRI's.
> >> Is this true?
>
> > I can't speak from experience, but I would suspect he is correct. The two
> > medications are in the same category (it's a small category), so it seems likely
> > that withdrawal effects would be minimized.After hearing about this on another board, I checked it out. Did you know that Paxil
> (paroxetine) has far higher norepinephrine transporter inhibition than does Effexor
> (venlafaxine)? Lower numbers are stronger inhibitors. From:http://kidb.cwru.edu/pdsp.php
>
> Paroxetine Ki (Inhibition Constant; nM)
> norepinephrine transporter 45
> dopamine transporter 963
> serotonin transporter 0.34
>
> Venlafaxine Ki (nM)
> norepinephrine transporter 1420
> dopamine transporter 3070
> serotonin transporter 102
>
> Of course, there are other considerations, not the least of which is dose. But how
> did Paxil come to be known as a selective serotonin inhibitor?
>
> Lar
My memory is a little hazy, but I remember reading somewhere that the
'selective' part of SSRI/SNRI has to do not so much with the serotonin
as it is being selective of the reuptake neurochemical. So maybe it's
that it's particularly selective/effective against one or more
particular chemicals. Like I said, this is just a theory based on a
hazy memory.
Plus, paroxetine is an older formula, back before there *were* SNRIs -
it was the first medication a psychiatrist tried for me, when I was 16.
Venlafaxine and duloxetine, on the other hand, are fairly new formulas
- what, from the past five years?
Besides, while it is an effective norepinephrine transporter, the
numbers on that chart are still blown away by its work with serotonin
transporting.
Nom dePlume
news:c62e2$45b9387e$d8a8762c$22...@NEXICOM.NET...
>
> "Nom dePlume" <nomdeplume1000-at-yahoo.com> wrote in message
> news:ep9b4...@news3.newsguy.com...
>> I can't speak from experience, but I would suspect he is correct.
>> The two medications are in the same category (it's a small
>> category), so it seems likely that withdrawal effects would be
>> minimized.
>
> After hearing about this on another board, I checked it out. Did you
> know that Paxil (paroxetine) has far higher norepinephrine
> transporter inhibition than does Effexor (venlafaxine)? Lower
> numbers are stronger inhibitors. From: http://kidb.cwru.edu/pdsp.php
>
> Paroxetine Ki (Inhibition Constant; nM)
> norepinephrine transporter 45
> dopamine transporter 963
> serotonin transporter 0.34
>
> Venlafaxine Ki (nM)
> norepinephrine transporter 1420
> dopamine transporter 3070
> serotonin transporter 102
>
> Of course, there are other considerations, not the least of which is
> dose. But how did Paxil come to be known as a selective serotonin
> inhibitor?
Now, that is wild. The prescribing information certainly says the
opposite:
"In vitro studies in animals also suggest that paroxetine is a potent
and highly selective inhibitor of neuronal serotonin reuptake and has
only very weak effects on norepinephrine and dopamine neuronal
reuptake."
I wonder if the nasty withdrawal effects of Paxil are a result of it
being a dual-reuptake inhibitor, like Effexor? I also wonder if the
prescribing information for Paxil needs to be changed.....
Larry Hoover
>
>
> Plus, paroxetine is an older formula, back before there *were* SNRIs -
> it was the first medication a psychiatrist tried for me, when I was 16.
> Venlafaxine and duloxetine, on the other hand, are fairly new formulas
> - what, from the past five years?
The patent on venlafaxine is about to expire, so it's been around for nearly twenty
years. Duloxetine is more recent (in North America).
> Besides, while it is an effective norepinephrine transporter, the
> numbers on that chart are still blown away by its work with serotonin
> transporting.
Perhaps so. See my comments to Nom.
Lar
Larry Hoover
> "Larry Hoover" <larry...@sympatico.ca> wrote in message
> news:c62e2$45b9387e$d8a8762c$22...@NEXICOM.NET...
>>
>> Paxil (paroxetine) has far higher norepinephrine transporter inhibition than does
>> Effexor (venlafaxine)? Lower numbers are stronger inhibitors. From:
>> http://kidb.cwru.edu/pdsp.php
>>
>> Paroxetine Ki (Inhibition Constant; nM)
>> norepinephrine transporter 45
>> dopamine transporter 963
>> serotonin transporter 0.34
>>
>> Venlafaxine Ki (nM)
>> norepinephrine transporter 1420
>> dopamine transporter 3070
>> serotonin transporter 102
>>
>> Of course, there are other considerations, not the least of which is dose. But
>> how did Paxil come to be known as a selective serotonin inhibitor?
>
> Now, that is wild. The prescribing information certainly says the opposite:
>
> "In vitro studies in animals also suggest that paroxetine is a potent and highly
> selective inhibitor of neuronal serotonin reuptake and has only very weak effects
> on norepinephrine and dopamine neuronal reuptake."
The absolute values of the paroxetine NE Ki might be deceptive, as the ratios of
5-HT to NE Ki might tell the true tale:
Ki Ratio 5-HT/NE:
paroxetine 7.6 x 10^-3
venlafaxine 7.2 x 10^-2
When I did the ratios mentally, I got similar values, but I must have made an order
of magnitude error. Given a targetted 50% inhibition of serotonin reuptake
transporters, venlafaxine has a much higher occupancy of the NE transporter than
does paroxetine. This is accomplished through the much higher dose of the the
former, when compared to that of the latter. Moreover, the O-desmethyl metabolite of
venlafaxine has similar Ki's to the parent. I couldn't find comparable data for
paroxetine.
Just for the record, Wyeth Pharmaceuticals has just received FDA approval to market
desvenlafaxine (O-desmethylvenlafaxine) as Pristiq. This is another one of those
blatant patent-extending moves, as venlafaxine's patent dies in 2008.
> I wonder if the nasty withdrawal effects of Paxil are a result of it being a
> dual-reuptake inhibitor, like Effexor? I also wonder if the prescribing
> information for Paxil needs to be changed.....
>
> --
> Nom dePlume, Ph.D.
> Why, yes, in fact, I am a rocket scientist.
Perhaps not. However, the discovery that paroxetine binds so readily to one
particular NE binding site certainly raises the possibility that others might be
even more influenced. Different tissues most certainly have different affinities for
ligands.
Lar
Jean S. Barto
started it after being off all meds for 21 months. I found it less calming
than Effexor, but it suppressed my appetite, whereas the Effexor stimulated
it. The main problem I had with Cymbalta is that it was very constipating,
so much so that I felt I had to discontinue it. It took me a month or more
to decrease the dose safely, from 60 mg, eventually down to 20 mg, then off
entirely. I thought I needed to start up with something again earlier this
fall, but after 4 days, got off it again, also due to the constipation
issues. *Nothing* seemed to help with this side-effect--so that's why I
stopped the med.
Hope this helps
On 1/25/07 8:47 AM, in article
1169732850.4...@j27g2000cwj.googlegroups.com, "TehDizzyBroad"
TehDizzyBroad
> I was on Cymbalta for about 7 or 8 months (Aug 2005 to March 2006)--I
> started it after being off all meds for 21 months. I found it less calming
> it. The main problem I had with Cymbalta is that it was very constipating,
> so much so that I felt I had to discontinue it. It took me a month or more
> to decrease the dose safely, from 60 mg, eventually down to 20 mg, then off
> entirely. I thought I needed to start up with something again earlier this
> fall, but after 4 days, got off it again, also due to the constipation
> issues. *Nothing* seemed to help with this side-effect--so that's why I
> stopped the med.
>
> Hope this helps
>
> On 1/25/07 8:47 AM, in article
>
> <adelw...@gmail.com> wrote:
>
> > It is helpful, thanks - any little bit of reassurance from people
> > in-the-know makes me a little more confident about making the switch.
> > The only thing I guess that concerns me now is if Cymbalta isn't right
>
> > On the upside, it looks like I've got an office buddy who's making a
> > med switch to Cymbalta too, so I've got a bit od a support system
> > kicking here, too!
>
> > On Jan 24, 11:20 pm, "Nom dePlume" <nomdeplume1000-at-yahoo.com> wrote:
> >> "TehDizzyBroad" <adelw...@gmail.com> wrote in
> >> messagenews:1169666139.8...@l53g2000cwa.googlegroups.com...
>
> >>> First post to this group-- first post to *any* Usenet group in a
> >>> long,
> >>> long time, so bear with me here. Looks I'm going to be longwinded,
> >>> getting all the details right![Deletia]
>
> >>> After discussing sedatives for nighttime, and disregarding it
> >>> because
> >>> of the very real possibility of wetting the bed, he recommended
> >>> of
> >>> Cymbalta, then going up to 60mg if needed after a week, but no more
> >>> than that. Cymbalta, he said, shows a lower prevalence of
> >>> side-effects
>
> >>> Now to the questions. Are you still reading?
>
Any perspective and personal experience helps.
So far, with the exception of mild side effects, I have not noticed a
real change in my mood/affect or stability between the Effexor and the
Cymbalta. This is a *good* thing. The Effexor, depression-wise, was
working far beyond what I had hoped.
The side effects... well, the ones I was trying to rid myself of seem
to be gone for the most part. There are new ones however - the stoned-
ness, the nausea, the fatigue - which seem to fit under the 'flu-like
symptoms' my doc warned me about. Hopefully, like most of the Eff-XR
side effects, these will pass in a week or two.
Still don't feel quite up to snuff to come to work, but someone's
gotta pay the bills, and pay for these meds!