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Author Topic: Duloxetine start-up and diazepam  (Read 597 times)

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Offline BusuB

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Duloxetine start-up and diazepam
« on: April 17, 2014, 12:07:25 PM »
Good morning AZ!  I just started a course of duloxetine about 12 days ago (30mg) and increased to 60mg 5 days ago after fluoxetine induced anxiety failed to abate after 12 weeks.  My pdoc rx'ed a small dose of diazepam (2mg) to help with some of the start up anxiety, but I've been hesitant to use it.  My anxiety is strongest in the morning when I get up and I've often thought that the diazepam could help but I'm hesitant considering my previous experiences with benzo's.

Alprazolam precipitated my first panic attack ever when the rebound anxiety hit.

Lorazepam didn't seem to have any effect.

Clonazepam was difficult to discontinue after 3 weeks consistent use.

My pdoc understands all this but is hopeful that the diazepam, with it's longer half life, shouldn't be of any issue as far as tapering (and the fact that he only provided 20 pills), yet I'm still gun shy.  At any rate has anyone else had any experience between the major benzo's and could you provide any opinions on the different effects?

Also, is anyone else on here on duloxetine?  It's definitely been more potent in the SE's than the SSRI's, not necessarily in the start up anxiety (actually not as bad) but in the brain fogginess and loss of appetite.  I hear it actually kicks in a little faster than the SSRI's.  Is that true?  Any input would be greatly appreciated.
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Re: Duloxetine start-up and diazepam
« Reply #1 on: April 17, 2014, 06:12:49 PM »
My pdoc understands all this but is hopeful that the diazepam, with it's longer half life, shouldn't be of any issue as far as tapering (and the fact that he only provided 20 pills), yet I'm still gun shy.

I agree with your psychiatrist. Diazepam is essentially self-tapering because of its long half-life, up to 200 hours. I'm not sure how helpful 2mg will be though as it's a tiny dose. BTW-you're already dependent on diazepam. It is the most prevalent of the natural benzodiazepines found in food.

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I hear it actually kicks in a little faster than the SSRI's.

I'm not sure this is the case. The limiting factor is how quickly neurogenesis produces new active neurons and how you respond to this, not the med itself. It is possible that the doubled barrel approach of the SNRIs (and TCAs) might speed up neurogenesis, but, afaik, there is no evidence for it.

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 BusuB

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Re: Duloxetine start-up and diazepam
« Reply #2 on: April 17, 2014, 06:17:17 PM »
My pdoc understands all this but is hopeful that the diazepam, with it's longer half life, shouldn't be of any issue as far as tapering (and the fact that he only provided 20 pills), yet I'm still gun shy.

I agree with your psychiatrist. Diazepam is essentially self-tapering because of its long half-life, up to 200 hours. I'm not sure how helpful 2mg will be though as it's a tiny dose. BTW-you're already dependent on diazepam. It is the most prevalent of the natural benzodiazepines found in food.

Quote
I hear it actually kicks in a little faster than the SSRI's.

I'm not sure this is the case. The limiting factor is how quickly neurogenesis produces new active neurons and how you respond to this, not the med itself. It is possible that the doubled barrel approach of the SNRIs (and TCAs) might speed up neurogenesis, but, afaik, there is no evidence for it.

Ian

The pdoc is hopeful it'll just take the edge off rather than nullify the start up anxiety.  One thing I've noticed with the duloxetine is that it makes me feel all jittery (ie, too much coffee) but no physical anxiety.
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Re: Duloxetine start-up and diazepam
« Reply #3 on: April 17, 2014, 07:14:33 PM »
One thing I've noticed with the duloxetine is that it makes me feel all jittery (ie, too much coffee) but no physical anxiety.

That is a side-effect of the increased serotonin activity. It usually diminishes after a few weeks though it can linger for some.

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 BusuB

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Re: Duloxetine start-up and diazepam
« Reply #4 on: April 18, 2014, 04:05:08 PM »
One thing I've noticed with the duloxetine is that it makes me feel all jittery (ie, too much coffee) but no physical anxiety.

That is a side-effect of the increased serotonin activity. It usually diminishes after a few weeks though it can linger for some.

Ian

Yeah it definitely lingered with the prozac  :sick0002:
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Re: Duloxetine start-up and diazepam
« Reply #5 on: April 18, 2014, 06:05:16 PM »
Yeah it definitely lingered with the prozac  :sick0002:

Prozac is the most stimulating of the SSRIs, and the second most of the antidepressants after Wellbutrin (bupropion). Zoloft also tends to produce jitters that overstay their welcome.  Just one of the 'joys' of the antidepressant magical mystery tour. :(

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 BusuB

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Re: Duloxetine start-up and diazepam
« Reply #6 on: April 25, 2014, 04:56:42 PM »
Thought I'd update.  Just completed week 3 on duloxetine, last 2 at 60mg.  Still having some tough moments here and there, particularly in the mornings.  Been experiencing early morning awakenings with this medication the last few days.  Not sure if medication or anxiety related.  I actually haven't had to take any diazepam since it's been prescribed, oddly enough.  Not that I'm never anxious, just not anxious enough to use it.  Some of the SE's have faded (particularly the fuzzy headedness), but I'm still pretty fatigued (maybe related to the early mornings), and mildly nauseated.  My wife commented that I'm complaining less, so I take that as a good sign.  Still, not too happy with where I'm at and was hoping to be at a better place at this point.  Early days still, I know.  Any way, that's where I am.
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Re: Duloxetine start-up and diazepam
« Reply #7 on: April 25, 2014, 06:22:34 PM »
Early days still, I know.  Any way, that's where I am.

You've only just entered the 3-12 week window in which antidepressants typically kick-in, so it is early days, however, the signs seem promising so hang in there. It can only get better from here on.

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 MLB2805

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Re: Duloxetine start-up and diazepam
« Reply #8 on: April 25, 2014, 09:00:05 PM »
I had good results with cymbalta ... Besides weight gain
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Offline BusuB

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Re: Duloxetine start-up and diazepam
« Reply #9 on: April 28, 2014, 07:59:16 PM »
I had good results with cymbalta ... Besides weight gain

If you don't mind my asking, how long was it before you felt good control of your anxiety?
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Offline MLB2805

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Re: Duloxetine start-up and diazepam
« Reply #10 on: April 29, 2014, 03:20:12 PM »
I'd say a couple weeks, about 4... I always check how I feel upon waking up and slowly I stopped doing this... I'd say I had just about full remission with cymbalta, here and there I'd have trouble sleeping,
And constipation, but I'd take anything over anxiety and my mind constantly having intrusive thoughts...
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Offline BusuB

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Re: Duloxetine start-up and diazepam
« Reply #11 on: April 29, 2014, 04:19:50 PM »
I'd say a couple weeks, about 4... I always check how I feel upon waking up and slowly I stopped doing this... I'd say I had just about full remission with cymbalta, here and there I'd have trouble sleeping,
And constipation, but I'd take anything over anxiety and my mind constantly having intrusive thoughts...

I tend to respond on the slower side so conservatively I'm looking at at 6 weeks for consistency.  But so far, I've seen some progress and that's good enough for me for now.

Thanks.
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Offline BusuB

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Re: Duloxetine start-up and diazepam
« Reply #12 on: April 29, 2014, 07:48:01 PM »
Whew... had a bit of a rough ride today anxiety wise.  Had a job interview today for a possible promotion at work and worked myself up subconciously about it.  Felt mildly jittery this morning, then it hit full on as I sat waiting for the interview to start.  Think I did okay though,  so that's good.  As I walked out of the interview room, it was as if I'd jumped into a Xanax bath and I immediately felt some relief from my jitteriness.  That wasn't long lived though.  Have been up and down on the anxiety front the remainder of the afternoon.  But the peaks of anxiety aren't as high as they were a couple weeks ago.  Progress at 3.5 weeks.... Damn anxiety makes us so impatient  :spineyes:
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Offline BusuB

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Re: Duloxetine start-up and diazepam
« Reply #13 on: May 08, 2014, 04:01:21 PM »
I'm so tired... from the moment I wake until I go to bed at night.  I don't know what to make of it.  My mood is so-so.  Not terribly sad.  I also notice that my vision is blurry off and on through the day. I have a follow up with my pdoc in 8 days time so I guess I'll assess where I'm at then.  That'll put me at 6 weeks total.

Right now, 1 week at 30 and 4 weeks (as of tomorrow) at 60.

SE's still dealing with:
Fatigue
Occassional dry mouth
Blurry/Foggy Vision
Headaches
Low libido and lowered response

Anxiety still going down, though still there off and on through the day.  Having to drink caffeine to combat the fatigue isn't helping.  Hard to stay motivated and focused at work.
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Re: Duloxetine start-up and diazepam
« Reply #14 on: May 08, 2014, 06:34:47 PM »
I'm so tired... from the moment I wake until I go to bed at night.  I don't know what to make of it.

Are you still taking diazepam? If so, it may be triggering a lot of the fatigue so try going without. It has a very long half-life so it may take nearly a week to make a difference. You could also try changing the time of day that you take the duloxetine.

Quote
Right now, 1 week at 30 and 4 weeks (as of tomorrow) at 60.

SE's still dealing with:
Fatigue
Occassional dry mouth
Blurry/Foggy Vision
Headaches
Low libido and lowered response

Most of these should ease as you adjust to the med. The ones likely to hang around are the dry-mouth and low libido. There are topical treatments for dry-mouth, but sipping water often is probably as effective and much cheaper. For the libido see here.

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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