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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by former poster on July 13, 2012, at 1:10:27
I'm going through some stressful events/crisis and I'm on Savella 100mg/day for Chronic pain/fatigue. Savella seemed to boost my mood, help with some social anxiety issues as well as the pain, CFS. Lately I can't seem to cope with situations in my life and I'm worried I'll be sinking into deep depression. Maybe I should increase Savella to 150 or 200mg? Or add Bupropion?
Posted by SLS on July 13, 2012, at 5:57:10
In reply to Savella augmenter suggestions anyone?, posted by former poster on July 13, 2012, at 1:10:27
> I'm going through some stressful events/crisis and I'm on Savella 100mg/day for Chronic pain/fatigue. Savella seemed to boost my mood, help with some social anxiety issues as well as the pain, CFS. Lately I can't seem to cope with situations in my life and I'm worried I'll be sinking into deep depression. Maybe I should increase Savella to 150 or 200mg? Or add Bupropion?
>I came across this a few years ago:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656309/
"Additional intermediate assessment of the high-dose milnacipran group showed that the effect of milnacipran was dose-dependent with an additional improvement when patients were increase from 100 to 150 mg/day. These results suggest that patients suffering from moderate to severe depression with relative high HAM-D scores may benefit from treatment with high-dose milnacipran."
- Scott
Posted by SLS on July 13, 2012, at 6:02:13
In reply to Savella augmenter suggestions anyone?, posted by former poster on July 13, 2012, at 1:10:27
> Or add Bupropion?
Good idea.
I forgot to mention that adding bupropion to a SRI is often successful.
People have forgotten about L-methylfolate (Deplin) as an augmenter. For some people, it unlocks the door.
If you decide to go the route of adding herbs and supplements, please post your results, good or bad. Thanks.
- Scott
Posted by Phillipa on July 13, 2012, at 10:00:12
In reply to Savella augmenter suggestions anyone?, posted by former poster on July 13, 2012, at 1:10:27
Have you also discussed the stressful stuff? Is there anything you can do to relieve or eliminate some of the stress. Make sure you get outside everyday if possible. Phillipa
Posted by former poster on July 13, 2012, at 22:39:45
In reply to Re: Savella augmenter suggestions anyone? » former poster, posted by Phillipa on July 13, 2012, at 10:00:12
Thanks for the precious info. Sounds like it could be the dose is too low at 100mg. I will consider upping the dose with Dr. approval.I'm taking a lot of Gotu Kola as an augmenter. Seems to have an astonishing effect.
Phillipa, I would like to discuss the stressful stuff and get some advice. Seems like my insurance only covers medication and not counseling, psychotherapy, CBT.
Maybe look for a crisis forum??
Posted by SLS on July 14, 2012, at 4:42:21
In reply to Re: Savella augmenter suggestions anyone? » Phillipa, posted by former poster on July 13, 2012, at 22:39:45
>
> Thanks for the precious info. Sounds like it could be the dose is too low at 100mg. I will consider upping the dose with Dr. approval.150 mg seems to be the "sweet spot" for Savella when treating more severe depressions.
> I'm taking a lot of Gotu Kola as an augmenter. Seems to have an astonishing effect.
In what ways does it affect you? What are some of its properties?
Thanks.
- Scott
Posted by former poster on July 14, 2012, at 12:57:25
In reply to Re: Savella augmenter suggestions anyone? » former poster, posted by SLS on July 14, 2012, at 4:42:21
Gotu Kola just seems to make me "right". I'm less anxious, less depressed, more motivated, more sociable, clear headed, focused. Absolutely no side effects. Americans are very naive when it comes to natural cures.
Gotu Kola is a big part of the Thailand (Isan region) cuisine. A huge mound of herbs are placed on the table or eating area. Thai people gobble up huge amounts of countless herbs. The most common herbs I have been able to identify or translate are Chilies, Thai basil, Holy Basil, Gotu Kola, Lemon Balm and other mint family. I was amazed to see fresh Gotu Kola put in a juicer and sold for $1.00 for 8 oz. in the outdoor market. Thai people sometimes call it "broken heart drink", because people with depression from a broken relationship seem to find relief from drinking it. I drink sometimes 2 bottles a day and eat about 20 leaves with the stems.
Posted by SLS on July 14, 2012, at 13:30:18
In reply to Re: Savella augmenter suggestions anyone? » SLS, posted by former poster on July 14, 2012, at 12:57:25
> Gotu Kola just seems to make me "right". I'm less anxious, less depressed, more motivated, more sociable, clear headed, focused. Absolutely no side effects.
Sign me up! That's amazing.
Very cool.
:-)
There's real medicine in plants. That's where most of man's drugs came from before the age of petroleum.
> Americans are very naive when it comes to natural cures.
I was optimistic when the U.S. National Institutes of Health launched a whole department dedicated to studying "alternative" treatments for disease. This occurred in 1993 just as I was leaving their clinical psychopharmacology program. What qualifies as "alternative", I do not know. I have never searched for the NIH activity in this area before just now. See what you think. You would understand more than I would.
- Scott
Posted by Phillipa on July 14, 2012, at 19:47:26
In reply to Re: Savella augmenter suggestions anyone? » former poster, posted by SLS on July 14, 2012, at 13:30:18
My friend's husband is a pdoc and is turning more and more to alternative meds. he suggestions via friend on facebook that Duke is also utilizing alternative meds instead of traditional and that I should check them out. I know from experience that arnica montana homeopathy definitely works. No swelling no bruising when used as directed even after an injury that would normany cause bruising. I must look up this herb. Doesn't a person need to be careful with them? Are there any alternative websites? I know many have done well with accupuncture. Thanks Phillipa
Posted by Phillipa on July 14, 2012, at 20:36:14
In reply to Re: Savella augmenter suggestions anyone?, posted by Phillipa on July 14, 2012, at 19:47:26
Posted by phidippus on July 17, 2012, at 19:12:45
In reply to Savella augmenter suggestions anyone?, posted by former poster on July 13, 2012, at 1:10:27
if your dealing with pain and mood issues, then I would have to recommend Tramadol. Attacks the pain and is a righteous little SNRI to boot.
Eric
Posted by brynb on July 17, 2012, at 21:13:02
In reply to Re: Savella augmenter suggestions anyone? » former poster, posted by phidippus on July 17, 2012, at 19:12:45
> if your dealing with pain and mood issues, then I would have to recommend Tramadol. Attacks the pain and is a righteous little SNRI to boot.
>
> Erici'm in agreement here. i've been taking tramadol for 5/6 weeks and it really helps my mood (worked immediately). it also works well on the pain i get in my legs and arms.
my pdoc wants me to go off it and start nortiptyline instead. i'd like to convince him to keep me on the tramadol--i have no side effects from it whatsoever, and it works well. why should i change something that's working??
-b
Posted by former poster on July 17, 2012, at 21:28:03
In reply to Re: Savella augmenter suggestions anyone? » phidippus, posted by brynb on July 17, 2012, at 21:13:02
Savella & Tramadol? Any risk of serotonin syndrome?
Posted by former poster on July 17, 2012, at 21:32:50
In reply to Re: Savella augmenter suggestions anyone? » former poster, posted by phidippus on July 17, 2012, at 19:12:45
Pain is still a big issue. Savella is not taking care of the pain adequately. However I do like the NE effects on my mood, focus.
Posted by brynb on July 18, 2012, at 8:46:39
In reply to Re: Savella augmenter suggestions anyone? » brynb, posted by former poster on July 17, 2012, at 21:28:03
> Savella & Tramadol? Any risk of serotonin syndrome?
Yes, there is a risk of serotonin syndrome when using high doses of Tramadol w/ SSRIs/SNRIs/etc., but at low doses it's fine (and no different than using something like a TCA w/ an SSRI). In fact, a lot of people use Tramadol w/ an AD.
I took 100 mg (50 am/50 pm) w/ 20mg of Lexapro for awhile, but now I'm down to just 50mg of Tramadol in the morning w/ 20mg of Lexapro at night. It's been a lifesaver for me; it lifted my mood within an hour, made me motivated and clearer, and worked well for the pain. That's why I don't want to eliminate it from my current regimen!
Definitely look into it, I honestly have had no side effects. Apparently it's not an easy drug to withdraw from, but neither are any of the psych meds!
Posted by former poster on August 23, 2012, at 1:41:45
In reply to Savella augmenter suggestions anyone?, posted by former poster on July 13, 2012, at 1:10:27
> I'm going through some stressful events/crisis and I'm on Savella 100mg/day for Chronic pain/fatigue. Savella seemed to boost my mood, help with some social anxiety issues as well as the pain, CFS. Lately I can't seem to cope with situations in my life and I'm worried I'll be sinking into deep depression. Maybe I should increase Savella to 150 or 200mg? Or add Bupropion?
>I tried 150mg/day for about 1 month. I noticed some improvement in mood. Maybe 200mg/day would have worked even better? I had to stop because of hot flashes and profuse sweating. I'm back on 100mg/day and the excess body warmth perspiration seems to still be a problem. Am I damaging my body with this drug? I don't really feel the serotonin reuptake effect. I have had other SSRI's and this doesn't feel anything like them.
Posted by phidippus on August 23, 2012, at 7:17:34
In reply to Re: Savella augmenter suggestions anyone? (Update) » former poster, posted by former poster on August 23, 2012, at 1:41:45
Savella is an SNRI that is not approved to treat depression in the US (are you in the US?) BUT, as a seratonin norepenephrine rreuptake inhibitor it will certainly confer antidepressant and anxiolytic effects-that's why it helped with your mood and social anxiety.
I'm sorry to hear things have gotten more stressful, but I think if you worry about becoming depressed it might put more pressure on you.
200 mg is the highest recommended dosage for Savella. If you had improvements at 150 mg, you might see more at the highest dose. I think the hot flashes will subside over time, however the profuse sweating may remain an issue-but its definitely about weighing pros over cons.
You are not damaging your body with this drug. If anything, it is neuroprotective.
If your mood is improving, you are feeling tthe benefits of seratonin reuptake inhibiition.
If you want to augment your treatment, I would recommend Lyrica or Tramadol-both treat fibromyalgia and Tramadol is an excellent mood enhancer. Bupropion might be helpful for your mood.
Eric
Posted by brynb on August 23, 2012, at 7:53:53
In reply to Re: Savella augmenter suggestions anyone? (Update) » former poster, posted by phidippus on August 23, 2012, at 7:17:34
> If you want to augment your treatment, I would recommend Lyrica or Tramadol-both treat fibromyalgia and Tramadol is an excellent mood enhancer.
>I'm on board with what Eric said above about Tramadol. It's been wonderful for me for both mood and pain. I wasn't able to tolerate any of the true NRIs (Cymbalta, etc.). They make me physically ill and just don't jive with my chemistry. Even though Tramadol works like an NRI, I can tolerate it.
Good luck,
-b
Posted by former poster on August 23, 2012, at 8:54:41
In reply to Re: Savella augmenter suggestions anyone? (Update) » former poster, posted by phidippus on August 23, 2012, at 7:17:34
Thanks for your post Eric. I asked my Dr. for a prescription of Tramadol and he refused because he said it's "very addictive." I might give the Bupropion a try in combination with it. Do you know of any SSRI's that would go well with Savella?
Posted by brynb on August 23, 2012, at 9:24:17
In reply to Re: Savella augmenter suggestions anyone? (Update), posted by former poster on August 23, 2012, at 8:54:41
> Thanks for your post Eric. I asked my Dr. for a prescription of Tramadol and he refused because he said it's "very addictive." I might give the Bupropion a try in combination with it. Do you know of any SSRI's that would go well with Savella?
Hi FP,
I just wanted to chime in again about Tramadol. A lot of pdocs won't prescribe it because it's technically not a "psych" drug. This so ridiculous; I mean if it works, it works. Who cares what it's characterized as? Yes, it's considered addictive, but again, that's nonsense; benzos are addictive, stimulants are addictive, and one can argue that SRIs and NRIs cause dependence too (it's certainly no picnic coming off of anti-depressants!).
If presented with the proper research/articles/etc., perhaps your doc would reconsider. It's an NRI that also works on the mu opioid receptors (it doesn't get you high at all) and apparently, as an NMDA antagonist, too. In working this way, it's a pretty effective AD (and good for pain).
My pdoc wanted me off of Tramadol (because I had substance abuse issues in the past), so to be a "good" patient and comply, I tapered off of it. I was surprised how easy it was (I was mildly sad for a few days, but also dealing with PMS!). I had my general internist refill my script so I could have it available and have only been using it as a prn.
Sorry for the rant, I just get incensed when doctors are too rigid in their approach to mental (or other) health issues. I'm seeing my pdoc in two weeks, and I intend to let him know how I feel about taking Tramadol.
Either way, good luck.
-b
Posted by former poster on August 23, 2012, at 12:57:47
In reply to Re: Savella augmenter suggestions anyone? (Update) » former poster, posted by brynb on August 23, 2012, at 9:24:17
Thanks for that input brynb. Unfortunate that the percentage of patients seeking a way to get high have to ruin it for the ones that truly need it. Then the government has to schedule it and play the role of baby-sitter at our expense and suffering.
Posted by former poster on August 23, 2012, at 13:53:40
In reply to Re: Savella augmenter suggestions anyone? (Update) » former poster, posted by former poster on August 23, 2012, at 1:41:45
I think Savella is a good appetite suppressant. I don't seem to gorge myself like I used to. It doesn't feel anything like an SSRI to me. No sedation. Ever! No cognitive impairment, memory impairment. I don't feel medicated. I feel like my natural self except for the headache and perspiration.
My sleep is improved but not perfect from Savella. I wake up after 5hrs of sleep, take my morning dose and I'm back to sleep for 3 more hrs. The afternoon dose is taken 6hrs before sleeping time. Deep sleep is something new for me since being on Savella.
I haven't found any med that has helped with social anxiety as much as Savella, except Nardil. I can't contribute all of my improvement to Savella because I'm also taking a number of supplements and herbs, most important Gotu Kola which has a stunning effect on sociability. I forgot to mention, I don't think it helps with my arthritis pain
I think Savella should be investigated further for it's benefit on sleep and anxiety. I hope this bit of rambling can benefit someone.
Posted by phidippus on August 23, 2012, at 17:16:12
In reply to Re: Savella augmenter suggestions anyone? (Update) » former poster, posted by former poster on August 23, 2012, at 13:53:40
Savella is an SNRI, not an SSRI.
Eric
Posted by phidippus on August 23, 2012, at 17:19:07
In reply to Re: Savella augmenter suggestions anyone? (Update), posted by former poster on August 23, 2012, at 8:54:41
What your doctor says is bullocks. Benzodiazapines are more addictive than Tramadol.
A good SSRI to compliment your Savella would be Viibryd, which is an SSRI plus 5ht1a partial agonist which is very good for depression and anxiety.
Did you ask about Lyrica?
Eric
Posted by former poster on August 24, 2012, at 1:05:48
In reply to Re: Savella augmenter suggestions anyone? (Update) » former poster, posted by phidippus on August 23, 2012, at 17:19:07
I saw my Dr. today and asked him if Tramadol would mix well. All I got out was, TRAMA- and he cut my sentence short saying "I'm not going to prescribe an addicting drug!" I felt like a junkie. Very humiliating to say the least. I have had it with this small town clinic.
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