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Author Topic: Cymbalta for anxiety and depression  (Read 333 times)

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Offline WCS

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Cymbalta for anxiety and depression
« on: April 01, 2014, 06:10:29 PM »
Hi All,
New here but have lurked for a little while and am very impressed with the active online support I see here.  Would like to ask you all your opinions on the tx I'm doing for anxiety and depression.  I hope I'm posting this in the right place.  And please forgive me if this is overly long.

First, some history.  I'm a 48 year-old male and was first diagnosed with anxiety and panic disorder 20 years ago.  I'd always been a rather intense young man, exercised a huge amount (e.g., 30-40 mile bike rides most days for a time period, eight-mile runs in the mountains most days for another period, hard manual labor jobs, etc...) since I was about 19 and that probably helped mask some symptoms, although I'd always had panic attacks in medical/doctor situations (no one ever called them panic attacks back then, though).  At 28 I was in grad school, not exercising as much, had a terrible relationship in which I was a rescuer of a self-destructive woman, my grandmother died, my dad died, and that's when the whole panic thing started.  Didn't get treatment until a year or two later, at which point a psych put me on Paxil.  Well, the Paxil killed my sex life for the most part, but it did stop anxiety and panic (except when at the doctor's).

At 31 I got a great job overseas, was happy, ran out of Paxil a couple years later at 33 years old and was fine.  I did start having anger and frustration problems, some "anger attacks" as I like to think of them, but no real anxiety, depression or anything like that.  However, the job ended when I was 38, I returned to the States, got married, got a 9-5 job, and I started getting the anxiety and panic attacks again.  I felt really trapped.  That was the key, I think, in triggering the attacks.  So at 40 years old I went back on the Paxil again, got sick of the side effects after a year and quit, and at 41 or 42 got put on the generic for Lexapro.  The Lexapro helped, it didn't have nearly the side effects of Paxil, and I just sort of went on with life, reasonably content although I gained about 40 pounds, but still struggling a bit with anxiety and panic.  The doc increased my dose on Lexapro from 10mg to 20mg after a couple of years (say at age 45).  Also had some alprazolam (Xanax) for the occasional panic attack, and 30 0.5mg pills would last me about six months.

Then, after being on the 20mg for a year, I began to get heart palpitations (cardiologist diagnosed as PVCs and wasn't too worried about them, but they were very uncomfortable and triggered severe anxiety/panic).  I would pop the Xanax as it was the only thing that would calm down the PVCs.  The doc and I never figured out that it was the Lexapro causing them until this January (age 48) when the generic I'd been on was replaced with a generic from another manufacturer (Cadista Labs).  Wow, whereas previously the PVC's would show up for a week or two and then go away, now the PVC's hit with a vengeance, more powerful, almost every heart beat, and it was horrible.  So I stopped the escitalopram (generic Lexapro) and the PVC's started to fade after a day or two.  Waited another day and they were mostly gone.  So I did an experiment and took a pill.  Bam, PVCs right away.  Waited another day or two for them to go away, then took half a pill.  Again, most PVCs.

So I went to my doc and told him what happened and that I wanted to see a psychologist to try some kind of "talk" therapy instead of meds.  I really should have been doing this all along, I realize that now, but it gets so darned easy to just get along when on a med.  Well, my anxiety of course increased, I used the Xanax to get by, but the counselor was really helping me in January and February.  I felt great about my progress against the anxiety, the book he'd given me (Mastery of Your Anxiety and Worry, by Craske and Barlow) was helping greatly by having me keep logs of feelings, thoughts, behaviors, etc..., but three weeks ago, wham! I got hit with depression.  I'd never felt anything like this except for immediately after deaths in the close family.

For no reasons that I could identify, I was overwhelmed with sadness, depression, hopelessness, and so forth.  The anxiety is less, maybe because the Xanax has helped with the depression (thank God).  The first week it hit I saw the counselor and he gave me some ideas for dealing with it, but I've had no progress.  The only thing that helps has been a 0.5mg Xanax or two a day.  For the past two weeks I was out of town, couldn't reach my doc, and I suffered mightily with the sadness and depression.  Today, I got back to town and talked with my doc who wants me to start taking Cymbalta for the depression.  What are your thoughts?  Is it worth a try?  My depression seems somehow connected to my anxiety, the fact that the Xanax helps with both seems to imply that, and the way I was using my own thoughts and the talk therapy was starting to beat the anxiety when the depression manifested also is suggestive of this.  Do you think my plan to take a low dose of Cymbalta to help with the depression and continue with seeing a counselor for fighting the anxiety is the right way to go?  Any further suggestions or advice?

Thank you in advance,
WCS
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Offline insights

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Re: Cymbalta for anxiety and depression
« Reply #1 on: April 02, 2014, 07:38:59 AM »
I felt great about my progress against the anxiety, the book he'd given me (Mastery of Your Anxiety and Worry, by Craske and Barlow) was helping greatly by having me keep logs of feelings, thoughts, behaviors, etc..., but three weeks ago, wham! I got hit with depression.  I'd never felt anything like this except for immediately after deaths in the close family.

Welcome to AnxietyZone,

Were you taking less Xanax in the lead up to the onset of depression?

Quote
Do you think my plan to take a low dose of Cymbalta to help with the depression and continue with seeing a counselor for fighting the anxiety is the right way to go?

A combination of both antidepressants and cognitive/behavioural/mindfulness therapies has consistently been shown to improve treatment outcomes in the long term so this is the ideal option.

However, whether low dose Cymbalta will help with the depression will depend on how you define "low dose". To ensure neurogenesis is initiated and sustained you should take at least 60mg/day, which is also the typical treatment dose. Taking less may be counterproductive as you be merely 'training' the brain to ignore the med.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline WCS

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Re: Cymbalta for anxiety and depression
« Reply #2 on: April 02, 2014, 10:55:30 AM »
Hi, Insights,
Thank you so much for your response.

I was taking more Xanax since quitting the escitalopram cold turkey in early January, but not every single day like I've been taking it since the depression hit.  Do you think the depression could be related to that?  The Xanax does reduce the depression somehow.  I would say that, since the depression hit a few weeks ago, I'm up to 0.75mg - 1mg of Xanax every day. 

I took my first Cymbalta today, a 30mg capsule, and we'll see how it goes along with the talk therapy, log keeping, exercise and so forth.  I'll keep in mind what you said about 60mg being the recommended dose.  Do you think Cymbalta is a good choice for someone with my history?  Or is it a case of it is a choice and see how well it works?
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Offline insights

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Re: Cymbalta for anxiety and depression
« Reply #3 on: April 02, 2014, 05:20:02 PM »
I was taking more Xanax since quitting the escitalopram cold turkey in early January, but not every single day like I've been taking it since the depression hit.  Do you think the depression could be related to that?

I had wondered if you'd stopped taking Xanax and the depression was a withdrawal effect, but this doesn't seem to be the case. However, it is possible that quitting the escitalopram cold-turkey created a vulnerability.

Quote
Do you think Cymbalta is a good choice for someone with my history?  Or is it a case of it is a choice and see how well it works?


Unfortunately, there is no predicting how someone will react to a particular antidepressant, or even antidepressants generally. I suspect that the PVCs were more a escitalopram specific issue than a general SSRI one as it, and its parent compound citalopram (Celexa), are known to have a much greater effect on the electrical system of the heart than other SSRIs.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline WCS

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Re: Cymbalta for anxiety and depression
« Reply #4 on: April 03, 2014, 04:55:37 AM »
Insights, thank you so much for your help.  You are a true hero.
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Offline insights

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Re: Cymbalta for anxiety and depression
« Reply #5 on: April 03, 2014, 07:11:31 AM »
You are a true hero.

 :-*  You're undermining all the hard work my wife has put into deflating my humongous ego. You are very brave! :winking0008:

Ian

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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline Sleepingbear

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Re: Cymbalta for anxiety and depression
« Reply #6 on: April 03, 2014, 02:53:10 PM »
Actually, there are similarities in our stores.   :P That being said, I was on Paixil 20 mg for a LONG time.  And then it just petered out.  Currently, I"m on Cymbalta 60 mg., for my anxiety with subsequent depression and it has been wonderful.  I feel like I'm getting my life back.  I started off on 30 mg., then have been on 60 mg for about 7-8 weeks.  I really noticed it kicked in at around 5-6 weeks.  I have Xanax to use as needed, but I really don't seem to need it much at all.  Initially, I was put on Lexapro, which did not improve anything and only made my anxiety worse----in fact, my 4 weeks on the Lexapro were some of the worst days I can ever imagine having (the anxiety was horrific).   Anyway, now, things are much better, combined with therapy, and I am very grateful.  Hang in there.
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Offline WCS

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Re: Cymbalta for anxiety and depression
« Reply #7 on: April 03, 2014, 05:14:30 PM »
Thanks Sleepingbear, I appreciate it.

And Insights, well, sorry to inflate your ego but I've seen how dedicated you are to helping people who post to this site.

Oh, btw, the Cymbalta seemed to be making me jittery, so without really giving it a chance I asked the doc to switch me to Prozac simply because my mom had taken that for a few years and it worked for her.  If it fails, I'll try the Cymbalta and hang in there longer than two days.  And another btw, I could feel the first Cymbalta actually helping out with the depression, so I know that drug has potential.  Was just concerned about the nervousness it seemed to give me.
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Offline insights

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Re: Cymbalta for anxiety and depression
« Reply #8 on: April 03, 2014, 05:31:11 PM »
Was just concerned about the nervousness it seemed to give me.

A lot of them do that initially. Zoloft (sertraline) seems to be the most likely too, followed closely by Prozac which is the most stimulating of the SSRIs. So you might have just jumped from the frying pan.... However, this is by no means universal with some finding Prozac sedating so YMMV. The fact your mom is doing well on it does improve the odds of success.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline WCS

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Re: Cymbalta for anxiety and depression
« Reply #9 on: April 05, 2014, 10:10:44 AM »
Was just concerned about the nervousness it seemed to give me.

A lot of them do that initially. Zoloft (sertraline) seems to be the most likely too, followed closely by Prozac which is the most stimulating of the SSRIs. So you might have just jumped from the frying pan.... However, this is by no means universal with some finding Prozac sedating so YMMV. The fact your mom is doing well on it does improve the odds of success.

Ian

LOL  Figures.  Would you say Prozac is more activating that Cymbalta?  I'd read the SNRI's tended to be more stimulating than the SSRI's.
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Offline insights

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Re: Cymbalta for anxiety and depression
« Reply #10 on: April 05, 2014, 06:07:17 PM »
Would you say Prozac is more activating that Cymbalta?

Yes. I'd classify Cymbalta as neutral, with about as many reporting sedation as stimulation. At high doses it tends to be more sedating as the norepinephrine reuptake inhibition increases.  However, this is all very much YMMV. The only way to know how Prozac will affect you is to try it. What affect has it had on your mom?

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline WCS

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Re: Cymbalta for anxiety and depression
« Reply #11 on: April 05, 2014, 08:36:28 PM »
Mom likes to say she can take a "horse pill" and not have any side effects.  :-)  So far I've only taken the Prozac two days, and, like the Cymbalta did during the two days I took it, the Prozac seems to help with the depression and it feels a bit stimulating as well.  It seems weird that I'm responding to both meds immediately rather than the usual 2-4 weeks, but I was on SSRIs off-and-on for 18 years, so maybe I'm now highly responsive to them in some sense.  Hard to say.  So I'll take the Prozac for a few weeks, so how it works, and if I don't like it then I'll try the Cymbalta again.
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