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Author Topic: SNRI vs. SSRI, Is an SNRI promising?  (Read 2108 times)

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Offline insights

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Re: SNRI vs. SSRI, Is an SNRI promising?
« Reply #10 on: April 11, 2014, 08:13:17 AM »
I'm kinda scared because I guess I thought ssris were the best treatment

No, not necessarily. They are just the latest type of antidepressants, and they generally have fewer ongoing side-effects, but the double barrel serotonin+norepinephrine (aka noradrenaline) hit of the SNRIs and TCAs has its advantages. Neither of the two best antidepressants for very severe, almost catatonic depression, Effexor (at high doses) and Remeron (mirtazapine), is a SSRI. However, this doesn't mean they are necessarily the best for less severe depression as both have disadvantages too. As I've posted previously, Effexor is just a SSRI at the doses most often prescribed, it can also be very difficult to discontinue, and Remeron is the antidepressant most likely to poop-out, plus it can produce severe carbohydrate cravings.

I think the TCAs have advantages over the SNRIs, but your doctor will probably prefer you try a SNRI first. Either Cymbalta (duloxetine), or Pristiq (desvenlafaxine) would be a good initial choice.

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 dannysmiles19

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Re: SNRI vs. SSRI, Is an SNRI promising?
« Reply #11 on: April 17, 2014, 10:58:49 PM »
Hey Ian, I was at the doctor's two days ago and he and I had an interesting meeting. It got to my head a little because he said something like this: Based on your response to the SSRIs and only feeling partial responses, we psychiatrists look at bipolar. You said you have had anger and depression, which is a classic sign of bipolar. and your mood instability.

well, in this meeting, regardless of the bipolar talk, he said he's going to take me off the viibryd and try something new. He said he will put me on cymbalta and lamictal. He said don't worry about labels, let's get you well first. If you do well without the lamictal, then bipolar may not be it. But he wants me to go on lamictal along with the cymbalta.

so now there's a bit of an issue. He said to me to taper off the viibryd starting with 40 every other day for a week and then 10 every day for a week. But do I take the cymbalta tomorrow as I am beginning my tapering process? or do I go through withdrawal during the taper and then start cymbalta? I'm confused. I know you cannot tell me what to do because you are not my doctor. but do you think he meant to take the cymbalta during the tapering process? and if I am bipolar, couldn't the cymbalta give me manic symptoms without the lamictal kicking in for weeks to months?
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Re: SNRI vs. SSRI, Is an SNRI promising?
« Reply #12 on: April 18, 2014, 12:19:06 AM »
Based on your response to the SSRIs and only feeling partial responses, we psychiatrists look at bipolar. You said you have had anger and depression, which is a classic sign of bipolar. and your mood instability.

If he is suggesting that a lack of response to SSRIs alone indicates bipolar then I don't believe this is right. There are many patients who don't respond well to SSRIs who aren't bipolar. Indeed, it could be argued that the SSRIs are not the best meds for depression. It is no coincidence that the antidepressants proven to be most effective for really deep, almost catatonic depressions aren't SSRIs but the SRNI Effexor (venlafaxine) and the noradrenergic and specific serotonergic antidepressant (NaSSA) Remeron (mirtazapine). SSRIs are the most often prescribed meds for depression not because they are intrinsically more effective than the alternatives, but because their side-effects profile is better, though even this is only partially true for Celexa (citalopram) and escitalopram (escitalopram).

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He said to me to taper off the viibryd starting with 40 every other day for a week and then 10 every day for a week. But do I take the cymbalta tomorrow as I am beginning my tapering process?

I don't understand the first sentence. Are you supposed to take 40mg Viibryd only every second day and 10mg Cymbalta on the alternate days? If so, it seems and odd way to do it, but your psychiatrist knows you and your history so there might be some method to this that I'm unaware of.

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and if I am bipolar, couldn't the cymbalta give me manic symptoms without the lamictal kicking in for weeks to months?

Cymbalta would be no more likely to trigger mania than the SSRIs. Lamictal may be beneficial even if you are not bipolar so is worth a shot.

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 dannysmiles19

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Re: SNRI vs. SSRI, Is an SNRI promising?
« Reply #13 on: April 18, 2014, 12:38:30 AM »
What I was saying was he said to take viibryd 40 mg every other day for a week, and then 10 mg viibryd every day for the week after and then stop. my question was do I take cymbalta during this entire process? cymbalta 30 mg during those two weeks?

and he said in bipolar people, they feel like the medication isn't as effective as it once was and in fact it is just a mood shift from the higher mood to the lower mood, not the medication losing efficacy. and he felt the need to prescribe lamictal alongside to prevent depression from coming back... he thinks bipolar is a possibility. He said that bipolar people don't get a full response whereas unipolar patients don't get mood instability and even out when the medication kicks in. but I know partial response isn't indicative of bipolar.

he feels like the mood instability is an existing problem and that a mood stabilizer along with the viibryd could have been the right way to go but he was willing to switch me to cymbalta to give it a fair trial. but mood instability happens during clinical depression recovery as well, right? I'm kind of lost as to whether or not I am more on the bipolar spectrum or more towards unipolar.
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Re: SNRI vs. SSRI, Is an SNRI promising?
« Reply #14 on: April 18, 2014, 02:29:14 AM »
What I was saying was he said to take viibryd 40 mg every other day for a week, and then 10 mg viibryd every day for the week after and then stop

Okay. It is still an odd way of doing it. The preferred way would be to taper the daily dose every 3 days or so, but there might be a reason why he wants it done this way.

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my question was do I take cymbalta during this entire process? cymbalta 30 mg during those two weeks?

If he didn't explicitly say so then I'm guessing he wants you off the Viibryd before starting the Cymbalta. But you should get a clarification on this.

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I'm kind of lost as to whether or not I am more on the bipolar spectrum or more towards unipolar.

I can't answer that. Nor will the results of taking Lamictal necessarily prove it as it can have positive effects on depression even in those that aren't bipolar.

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 dannysmiles19

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Re: SNRI vs. SSRI, Is an SNRI promising?
« Reply #15 on: April 18, 2014, 08:58:58 PM »
Well based on your knowledge, do people take SNRIs while tapering from a SSRI? interactions aren't typically a problem? I'm not going to act based on what you tell me, I'm just curious as to what is typical. I'm going to call the doctor tomorrow to clarify what he wants me to do.
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Re: SNRI vs. SSRI, Is an SNRI promising?
« Reply #16 on: April 18, 2014, 10:11:14 PM »
Well based on your knowledge, do people take SNRIs while tapering from a SSRI?

Usually, they are tapered off the SSRI while tapering onto the SNRI (or vice versa). However, where there is a problem with a med then it can be better to discontinue one antidepressant before starting the other so there is no confusion about which is causing the problem. The downside is that this takes much longer and may subject the patient to weeks of coping first with withdrawal effects and then startup side-effects. 

Personally, except when MAOI class antidepressants are involved, I think cross tapering is the best option in most cases.

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.

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Re: SNRI vs. SSRI, Is an SNRI promising?
« Reply #17 on: April 23, 2014, 03:45:24 PM »
He meant to cross taper. he meant to wean off of the viibryd while taking the cymbalta. There's a problem going on now that is hard to ignore. I am pretty sure I am experiencing withdrawal symptoms from the viibryd. the tapering plan is 40 every other day for a week and then 10 every day for a week. I am scared that I won't be able to get off of viibryd... and if I keep taking cymbalta wouldn't that raise my risk for complications as the cymbalta builds a blood level in my system...

so if the cymbalta goes up in my blood...what do I do about the viibryd if the withdrawals are awful? or does the cymbalta built up in my blood compensate for the viibryd going down?
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Re: SNRI vs. SSRI, Is an SNRI promising?
« Reply #18 on: April 23, 2014, 06:03:47 PM »
what do I do about the viibryd if the withdrawals are awful? or does the cymbalta built up in my blood compensate for the viibryd going down?

Yes, that is what is supposed to happen.

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.

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Re: SNRI vs. SSRI, Is an SNRI promising?
« Reply #19 on: April 29, 2014, 11:28:29 PM »
Well it seems that's what is happening. The viibryd chemical is leaving my system successfully, IMO. The backlash is apparent, however. The benefits from the viibryd go with the drug leaving, so I think there's a tough transition going on. After I began the new pills, I felt a sense of hope and I even felt some ups at times. Now I feel like crap, and I really am doubting that's placebo because I know these pills can have pretty quick effects on people.

What is your take on Lamictal? I know it's not only a bipolar medication, but is it a good depression medication? I researched that it actually prevents depression. Obviously it has not been an adequate amount of time on these drugs whatsoever. It's been a week and four days approximately. That's a fraction of the time it takes for neurogenesis and for the lamictal to take effect.

So, how will I know when and if these pills yield positive results? and when should i even expect start up side effects to subside? I know startup anxiety and depression is a commonality. They can actually worsen things before making things great. so...any advice? This transition feels like it's gonna be one heck of a journey.
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