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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by jms600 on December 19, 2008, at 17:55:00
Hi everyone,
I have an appointment with my psychiatrist on Monday and I'm going to ask him to stop prescribing amitriptyline. I've been up to 200mg and it hasn't really done a thing to help my anxiety (chronic Generalised Anxiety Disorder, panic disorder, social phobia).
I'm now down to 100mg due to the side effects (which I still get), so I really feel I should be trying something else.
I've considered trying Cymbalta/duloxetine. Is it any good for GAD? What about panic disorder? Also does it 'poop out' as the SSRIs do?
I'm also on lithium - 600mg and buspirone - 40mg.
Thanks!
Posted by bleauberry on December 19, 2008, at 19:37:07
In reply to Cymbalta and anxiety, posted by jms600 on December 19, 2008, at 17:55:00
There is no way to predict in any individual whether a particular drug will address their anxiety or panic disorder. Cymbalta has been shown in clinical studies to be an effective choice. But of course, it only takes 50% improvement in clinical studies to be called success, and usually only 30% to 60% of patients get there. Here and in other forums some people have found cymbalta very effective, some not. It is like anything else. Very individualistic.
I wonder why something like low dose Klonopin, Xanax, or Ativan hasn't been tried? Your symptoms are what those address better than anything other choices. While some doctors frown on them due to potential tolerance or addiction, they are the most commonly prescribed meds on the planet and have been for decades.
Did you ever consider that maybe Buspar is contributing to the symptoms? While generally effective (50% improvement in 60% of people), it does have a possible side effect of...anxiety. When Buspar is metabolized in your system, one of its byproducts is a powerful norepinephrine stimulator. For people with susceptible chemistries, that spells anxiety, not anti-anxiety.
The amitriptyline by itself might have worked better than with buspar.
In any case, doctors seem to allow patients to suffer one ssri/snri after another hoping to get lucky eventually. Sometimes years go by. All this when a respectful tactful use of low dose benzo can end the symptoms immediately.
Back to cymbalta, it is worth a try. But I would consider putting a low dose benzo in there right away. For anxiety, the antidepressants with the strongest/longest track records are probably celexa, paxil, lexapro, zoloft.
Posted by desolationrower on December 19, 2008, at 23:50:09
In reply to Cymbalta and anxiety, posted by jms600 on December 19, 2008, at 17:55:00
You should try benzos, a neuroleptic, or nardil. Sometimes the drugs that 'work' for a mental disorder just don't for someone's brain.
Buspirone can help some people, have tried going up to say 100mg? I might do that and see if you notice something.
-d/r
Posted by Phillipa on December 20, 2008, at 0:21:24
In reply to Re: Cymbalta and anxiety, posted by desolationrower on December 19, 2008, at 23:50:09
How bout benzos with low dose of an ad? Love Phillipa
Posted by jms600 on December 20, 2008, at 12:17:09
In reply to Re: Cymbalta and anxiety » jms600, posted by bleauberry on December 19, 2008, at 19:37:07
Benzos, unfortunately aren't a long term option for me. Even with using them only once or so a week, I still developed a tolerance. Therefore I keep them now only for very bed episodes when I'm in deep despair.
I don't mind the 'addictive side' to them - it's the tolerance I want to avoid again. Although I need a daily anxiolytic - I also need something to fall back on as a last resort. Something that GUARANTEES me relief. If I use benzos every day, not only will I become tolerant to their beneficial effects and consequently my anxiety will get worse, but I will also have nothing to fall back on when my anxiety is severe.
I've also worked my way through every SSRI. They either didn't help much or 'pooped out'.
> There is no way to predict in any individual whether a particular drug will address their anxiety or panic disorder. Cymbalta has been shown in clinical studies to be an effective choice. But of course, it only takes 50% improvement in clinical studies to be called success, and usually only 30% to 60% of patients get there. Here and in other forums some people have found cymbalta very effective, some not. It is like anything else. Very individualistic.
>
> I wonder why something like low dose Klonopin, Xanax, or Ativan hasn't been tried? Your symptoms are what those address better than anything other choices. While some doctors frown on them due to potential tolerance or addiction, they are the most commonly prescribed meds on the planet and have been for decades.
>
> Did you ever consider that maybe Buspar is contributing to the symptoms? While generally effective (50% improvement in 60% of people), it does have a possible side effect of...anxiety. When Buspar is metabolized in your system, one of its byproducts is a powerful norepinephrine stimulator. For people with susceptible chemistries, that spells anxiety, not anti-anxiety.
>
> The amitriptyline by itself might have worked better than with buspar.
>
> In any case, doctors seem to allow patients to suffer one ssri/snri after another hoping to get lucky eventually. Sometimes years go by. All this when a respectful tactful use of low dose benzo can end the symptoms immediately.
>
> Back to cymbalta, it is worth a try. But I would consider putting a low dose benzo in there right away. For anxiety, the antidepressants with the strongest/longest track records are probably celexa, paxil, lexapro, zoloft.
Posted by manic666 on December 20, 2008, at 12:39:28
In reply to Unfortunately, benzos are not an option..., posted by jms600 on December 20, 2008, at 12:17:09
ok cymbalta i am on cym , 40, mg i have been up to 120mg it makes no difference. i am comming off cym its ok for mild depression but for me anxierty is worse, you will need a benzo , a least to start. i take 4 mg of loz i dont want to but been on to long addicted. but you will need one short or long term with cym , my opinion is its not the med for anxierty.
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