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
poster:zatar
thread:830578
URL: http://www.dr-bob.org/babble/20080519/msgs/830944.html