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Author Topic: Duloxetine start-up and diazepam  (Read 811 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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You don't have to control your thoughts. You just have to stop letting them control you.

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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