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Re: Cymbalta vs Effexor » Jaspar

Posted by SLS on May 28, 2006, at 19:47:18

In reply to Re: Cymbalta vs Effexor, posted by Jaspar on May 28, 2006, at 19:16:12

> > What is your friend suffering with?

> He has depression and generalized (but severe) anxiety - no panic attacks. Because of a life situation, his anxiety and depression has increased, and his motivation has decreased. I know the Cymbalta & Effexor can help the motivation issue. I don't understand how they can help the anxiety since norepinepherine is already supposed to be HIGH in anxiety.

The brain is unimaginably complex. One must think in terms of circuits and signal routing in addition to neurotransmitters and receptors. Neurotransmitters perform different functions depending on the location of their receptors. The serotonergic effects of Effexor and Cymbalta are stronger than their effects on norepinephrine. Serotonin is very often an inhibitory neurotransmitter and can reduce anxiety if certain circuits are activated. Of course, too much serotonin in certain areas actually produces anxiety. Although nortriptyline and desipramine are both TCA drugs that favor norepinephrine, they are known to reduce anxiety in some people. It is so difficult to predict how any one person will respond to any one drug. Sometimes, a serotonin reuptake inhibitor will produce anxiety during the first few weeks of treatment which disappears and is replaced by an antidepressant and anti-anxiety effect. This often occurs with Lexapro and Prozac.

Effexor + Klonopin is a combination often used to treat comorbid depression and GAD. An alternative is to use Nardil. Nardil is a mono-oxidase inhibitor (MAOI) used to treat depression and anxiety disorders. It is a drug for which one must adhere to a special diet devoid of tyramine and avoid certain medications. It sounds scary, but it really isn't that difficult to manage. I wouldn't look to it as a first choice, though.

Psychotherapy makes for a great adjunct to medication and can help prevent future occurrences. As with medication, therapeutic modalities are chosen which are best suited to the condition to be treated. Also, as with medication, there are often debates as to which modalities are the most effective for any one condition. I like CBT and IPT.


- Scott

 

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