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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by vic80 on May 15, 2010, at 13:33:55
Currently tapering down Lexapro 10mg > 7.5mg(today) 2 days > 5mg 2 days > 2.5 mg 2 days > stop (6th day from today) (have already been tapering down lex from 20mg a month ago > 15 mg > 12.5 mg 10 days ago > 10 mg a week ago)
tapering down Lorazepam - 0.5 - 0.5 - 1.0mg -> 0.5 - 0 - 0.5mg for the next 7 days
Started on Milnacipran 25mg Today morning:
Felt nausea - tingling in the legs and an increased heart rate. Plus some strange sort of fatigue and aches in the lower body.Past few days I have been going crazy - songs and words stuck in the head - constant mind chatter, unreality and a general feeling of going crazy - this could well be the lexapro withdrawal.
I didnt feel any difference emotionally through the day after taking MIL 25mg in the morning, I noticed an elevation in mood in the evening - which was not abnormal or even remotely hypomanic. (could well be lex taper)
been having shivers in my scalp/cranium past few days esp. on the right side. Today I noticed the shivers/zings in other joints of the body too - mainly knees and hips....never the less I was all over the place as usual - feeling completely spaced out - this is normal on lex taper I guess.
I have tried VenlafaxineXR in the past but a single dose taken in the night made me feel like my brain was totally frozen next day. COuldnt think or feel - was just sitting and staring at the walls.
What I felt 12 hours after taking my Milnacipran is just similar a monotonous mood - not happy not sad - not bothered - not scared not angry - nothing. PLus its difficult to think.
have constant aches/tingling through the body at different points - back aches and my heart rate is 96.Could it be that i react badly to NE re-uptake drugs..
I have heard a lot of praise for Milnacipran - but its mode of action is through the inhibition of NE and serotonin re-uptake which makes it quite similar to Venlafaxine (except that MIL has much higher NE reuptake Inhibition).
My main concern is persistent apathy and anhedonia which started during lexapro, my doc thinks Milnacipran would help address this and make me feel more motivated and emotional, would also help with the underlying anxiety etc.
There isnt much info on Milnacipran on the internet, except that its reportedly as good as TCAs in crushing depression minus the dirty effects.
Any inputs on Milnacipran's efficacy on OCD (mainly obsessive) and Depresonalization/Dissociation?
Posted by Phillipa on May 15, 2010, at 17:14:28
In reply to Starting Milnacipran, posted by vic80 on May 15, 2010, at 13:33:55
I may have missed it but you say you are tapering ativan at same time? One med at a time is reasonable. two is a lot. Phillipa
Posted by bleauberry on May 15, 2010, at 20:47:41
In reply to Starting Milnacipran, posted by vic80 on May 15, 2010, at 13:33:55
I do believe milnacipran will help with the apathy anhedonia stuff. For me that didn't really start to happen until the end of the second week on it.
I think overdosing on any reuptake inhibitor...NE or serotonin, doesn't matter...will cause the apathy thing. And in my opinion, milnacipran is dosed much too high. Not that the high doses aren't fine for some people, I just think they are over-assumed as being the standard for everyone. To me, a 25mg dose is a high starting dose. The starter pack begins with 12.5mg. For me, 6.25mg 3 times a day was my window of opportunity. Any higher and any lower, problems.
Just something to think about. Don't take the assumed doses for granted.
People who went all the way through long clinical trials said that milnacipran somehow reset thyroid and adrenal stuff, resulting in people who were always cold feeling normal instead. This happened months into treatment. The point is, milnacipran will have downstream effects in regulating things within you that are probably out of whack. Those things take a lot of time. And when they begin to change, as on the first dose, you will feel weird stuff. Add to that the withdrawals of the other meds, and yeah, you're gonna feel a bunch of weird stuff for a few weeks. No way around that.
Effexor doesn't have much impact on NE, so I doubt that was a factor in you feeling what you did when you tried it. It was almost totally serotonin. As well as whatever other unknown things effexor does that haven't been pinpointed yet.
Posted by SLS on May 16, 2010, at 5:03:47
In reply to Re: Starting Milnacipran, posted by bleauberry on May 15, 2010, at 20:47:41
> I think overdosing on any reuptake inhibitor...NE or serotonin, doesn't matter...will cause the apathy thing.
How do you define overdose?
I don't find this to be the case. None of the tricyclics treat me this way - even at dosages in excess of the maximum recommended. I don't think Effexor had this effect, either. For me, Lexapro was pretty bad. So, I guess there is some interindividual differences in the way the different antidepressants produce apathy.
- Scott
Posted by vic80 on May 16, 2010, at 11:57:58
In reply to Re: Starting Milnacipran, posted by bleauberry on May 15, 2010, at 20:47:41
Hi Bleauberry,
Thanks for your inputs regarding Milnacipran.
firstly, theres no doubt that diff people react diff to meds, the mileage may vary etc etc, but how would you rate your experience over all?
How long did you take/ are taking MIL?
and if you stopped what was the reason behind it?I have noticed tachycardia - pulse hasnt been below 96 since I started yesterday. And also I have found that I get a sense of uneasy calm - head-feels-blocked sort of calm - and theres increased irritability too.
I have noticed an elevation in my confidence in social situations and for the first time in months, just for a few minutes I could actually feel involved emotionlly in a social gathering without that 'invisible veil' thing.
(But that could be the 0.5 mg lorazepam I had taken a 15 mins before.)Over all it reminds me a bit of Remeron (caused me to have hypertension and severe anhedonia in just 10 days, not to mention the Movie-star dreams which was kind of fun come to think of it)
I have Depersonalization symptoms too but are either iatrogenic (started in 2nd week lex) or comorbid with depression. OCD (mainly O) too has exacerbated DP symptoms.
would you know of any positive results in DP, assuming you must have researched into MIL while on it! I have been unusually unsuccessful with googling about it.
I think as you have pointed out apathy caused by high serotonin could also be because I am taking lexapro 7.5 mg (plus the build up of several weeks in my system) which is a seriously potent serotonin RI. The combined effect of MIL and Lex on Serotonin RI must be a cause of the mental deadness i felt.
I am a bit apprehensive about the mood and confidence elevation I have felt even though subtle in the past 2 days - it has been too sudden and feels a bit false. I guess Lex taper/withdrawal too could induce mild hypomania.
Did you experience any mood swings/hypomania or irritability on MIL?
With a lot of difficulty I have reconciled to the fact that psychoactives arent a smooth ride after all but I am pinning a lot of hope on MIL.
Posted by bleauberry on May 16, 2010, at 16:15:05
In reply to Re: Starting Milnacipran, posted by SLS on May 16, 2010, at 5:03:47
>
> How do you define overdose?Too much.
>
> I don't find this to be the case. None of the tricyclics treat me this way - even at dosages in excess of the maximum recommended. I don't think Effexor had this effect, either. For me, Lexapro was pretty bad. So, I guess there is some interindividual differences in the way the different antidepressants produce apathy.
>
>
> - ScottExactly. You said what I was trying to say, except only better.
Posted by bleauberry on May 16, 2010, at 16:37:59
In reply to Re: Starting Milnacipran, posted by vic80 on May 16, 2010, at 11:57:58
>
> firstly, theres no doubt that diff people react diff to meds, the mileage may vary etc etc, but how would you rate your experience over all?Except for the total inability to pee, very promising. At 2 weeks I was socially comfortable, waves of having more energy and endurance, slept good, breaking out of procrastination and starting to get things done, planning, but most importantly was showing a lot of interest in things I previously liked to do.
> How long did you take/ are taking MIL?
> and if you stopped what was the reason behind it?It was around the 2 week mark. I did feel an initial bump within 24 hours which was obviously the rapid elevation of NE and dopamine. That went away quickly as I awaited the downstream effects.
>
> I have noticed tachycardia - pulse hasnt been below 96 since I started yesterday. And also I have found that I get a sense of uneasy calm - head-feels-blocked sort of calm - and theres increased irritability too.That to me says too much NE too fast. Again, I think the dosing is too aggressive as a blanket strategy for everyone. The starter pack begins with 12.5mg. For some people, in my opinion more than they think, it should probably stay there for at least a week or two. Some people, such as SLS, are able to handle large doses with hardly any effect. I think that is the exception rather than the norm. Just opinion. I could be wrong.
I think rapid elevation of NE is a totally different ballgame than rapid elevation of serotonin.
> would you know of any positive results in DP, assuming you must have researched into MIL while on it! I have been unusually unsuccessful with googling about it.I am not well informed on DP. I think I have probably experienced it, but I just don't know enough on that topic.
>
> I think as you have pointed out apathy caused by high serotonin could also be because I am taking lexapro 7.5 mg (plus the build up of several weeks in my system) which is a seriously potent serotonin RI. The combined effect of MIL and Lex on Serotonin RI must be a cause of the mental deadness i felt.A pure instinctual hunch here based on your overall comments thus far. I wouldn't be surprised if something like a 2.5mg lex + 12.5mg miln might be good in your case. It sounds like you could have a narrow window where it is easy to overdose and easy to underdose. Or I could be totally off base. Just my thoughts.
>
> I am a bit apprehensive about the mood and confidence elevation I have felt even though subtle in the past 2 days - it has been too sudden and feels a bit false. I guess Lex taper/withdrawal too could induce mild hypomania.Yeah. That phenomenon has been felt by some of us when getting off an ssri. I think it is the dopamine system coming back to life. Short lived until the feedback loops figure out what's going on, and then it's back to the old crap again. But then again, it could also be the rapid elevation of NE. I have felt both of those. The only difference was that the NE mood boost had more of an edgy nervous irritable kind of twist to it. Again, too much too fast. I think NE needs more time than serotonin when making changes, and that small steps makes that smoother. I mean, when you're messin with NE, you're messin with adrenals, thyroid, and stuff.
>
> Did you experience any mood swings/hypomania or irritability on MIL?Yes. I lowered the dose to a tolerable level and proceeded. In my case that meant 6.25mg twice a day and then up to 6.25 three times a day. I've gotten pretty good at the art of making custom sized doses out of either tabs or capsules. For some of us in the sensitive crowd, there is no choice but to do that.
>
> With a lot of difficulty I have reconciled to the fact that psychoactives arent a smooth ride after all but I am pinning a lot of hope on MIL.
>
>The ones in clinical trials and at forums who have had the best success with miln were the ones that waited and endured patiently during a rough ride. I remember two striking examples. One experienced total remission of all psychiatric and physical symptoms, but not until 6 months. Another was 9 months. In both cases the only side effects at that point were blood pressures higher than where they started and more sweating. The only reason either of them stayed the course that long was because they were in a clinical trial. Pretty much all the rest of us would have given up by then.
Posted by SLS on May 16, 2010, at 18:43:30
In reply to Re: Starting Milnacipran, posted by bleauberry on May 16, 2010, at 16:15:05
> >
> > How do you define overdose?
>
> Too much.
How does one know in advance how much medication will be needed to produce an antidepressant response two weeks later? Drug companies would prefer that their drugs be effective at a dosage that does not produce side effects - the minimum effective dose. They do spend time and money to conduct dosage studies to arrive at a therapeutic range. Do you think that these should be ignored?
- Scott
Posted by conundrum on May 17, 2010, at 17:43:15
In reply to Re: Starting Milnacipran, posted by bleauberry on May 16, 2010, at 16:37:59
> The ones in clinical trials and at forums who have had the best success with miln were the ones that waited and endured patiently during a rough ride. I remember two striking examples. One experienced total remission of all psychiatric and physical symptoms, but not until 6 months. Another was 9 months. In both cases the only side effects at that point were blood pressures higher than where they started and more sweating. The only reason either of them stayed the course that long was because they were in a clinical trial. Pretty much all the rest of us would have given up by then.
>
>Most would have given up and who can say for sure whether the drug helped the rest? Maybe their symptoms went away naturally and aren't these people in trials often given concommitent psychotherapy? 6 months is crazy for something that may not work, but I guess a lot of them must have been at the end of the rope if they were enrolling in a drug trial.
Posted by bleauberry on May 18, 2010, at 15:31:15
In reply to Re: Starting Milnacipran » bleauberry, posted by conundrum on May 17, 2010, at 17:43:15
Yeah, the whole pharmacology game sucks pretty bad. It's the best human science has to offer at this point. So, kind of stuck between a rock and hard place.
>
> Most would have given up and who can say for sure whether the drug helped the rest? Maybe their symptoms went away naturally and aren't these people in trials often given concommitent psychotherapy? 6 months is crazy for something that may not work, but I guess a lot of them must have been at the end of the rope if they were enrolling in a drug trial.
Posted by ed_uk2010 on May 18, 2010, at 16:04:45
In reply to Re: Starting Milnacipran » bleauberry, posted by conundrum on May 17, 2010, at 17:43:15
>6 months is crazy for something that may not work...
6 months sounds like the time to spontaneous remission.
Posted by conundrum on May 18, 2010, at 17:05:46
In reply to Re: Starting Milnacipran » conundrum, posted by ed_uk2010 on May 18, 2010, at 16:04:45
and a good amount of time for drug companies to generate profits if they got everyone believing it took that long for the drugs to work...
Also I believe a lot of people in med trials are getting therapy, I think its often included in being part of the trial. However, everyone is different and I don't doubt at all that for some people it takes that long to know what will happen. I've heard similar things with pristiq, that it takes a while to even out. I wonder if its because the drug works on two brain chemicals? I think SSRIs don't tend to cause ups and downs during start ups like some of the SNRIs seem to.
Posted by Phillipa on May 18, 2010, at 20:25:33
In reply to Re: Starting Milnacipran » ed_uk2010, posted by conundrum on May 18, 2010, at 17:05:46
14 years and no remission of a thing does this mean not depressed? Phillipa
This is the end of the thread.
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