Re: Questions about meds?
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Originally Posted by
pokerfan
1. Ian do you remember my post from AZ last year?
Sure do, though I'd forgotten some of the details - just another sign of the advancing years :weep: - so thanks for the recap.
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Should i just stick it out on the cymbalta for a bit long to see if i can come out of it? Im not suposse to see the doc again till the end of the month.
After nearly 3 months at 120mg it might be time to pulls the plug. I definitely would if there isn't a significant improvement by the end of the month.
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Ive tried 2 ssri and now an snri and im having trouble finding something that clicks with me. I know TCAs are an option but im a bit concerned with these. I know they have more side effects.
Well so far you've been playing with popguns. It might be time to bring out the TCA cannons. Either imipramine (Tofranil), or clomipramine (Anafranil) would be good initial choices. The latter is the more potent of the two - and arguably the most potent non MAOI antidepressant currently on the market, but it can be a more sedating than imipramine.
The TCAs can produce more ongoing side-effects, mostly nuisance ones such as dry-mouth and constipation which are manageable. I was on 350mg of imipramine for several years and and the side-effects weren't too bad, but YMMV.
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Plus i believe there is some interactions with food and alcohol.
Only the MAOI class antidepressants have food restrictions, but thanks to modern food processing techniques this is now much less of an issue then when I tried one nearly 30 years ago. Plus, adding a moderate dose of one of the norepinephrine/noradrenaline reuptake inhibitors such as the TCA nortriptyline (Pamelor) blocks the tyramine pressor response making it possible to eat nearly everything.
Alcohol should be limited with all antidepressants. The TCAs are no worse than the others.
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Have you heard of ADs causing a decrease in white blood cells.
Yes. It isn't a listed duloxetine side-effect, but there are isolated case reports of it occurring with nearly every antidepressant (and many other medications). Adding some lithium will usually correct the problem and may be beneficial for anxiety too.
UPDATE: Low white blood cell count - leukopenia - wasn't listed in the duloxetine monograph I looked at, but it is listed in the Patient Information data - p11, PDF, as is increased WBC count.
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4. In the blood work it also showed that i have the double recessive gene in the mthfr 677C>T. So about 2 weeks ago i started taking enltye again. Do you think this is a waste of time or something that could help me.
I keep reading about how great enltye type supplements are, but the handful of AZ posters that tried it were disappointed so I'm not convinced by the hoopla. However, there's probably no harm in taking it...except maybe to your wallet, and who knows, the microbes living in your sewer may get a kick out of it. :D
Re: Questions about meds?
Thanks for the quick response.
You mentioned that Anafranil is the most potent AD. What does this mean exactly. I guess my question is what makes it more potent? Couldnt you just take more of another AD to increase the potency or do they not work this way?
Also my doctor was talking to me back in December before i had a bit of a remission about the next possible choice of ADs. When i was on zoloft i had a bit of an issue with delayed ejaculation. That has pretty much gone away with the cymbalta. her thought was this might mean that i am lacking a bit on the serotonin part of the snri. Since my family has had some success with Prozac she thought we might try dropping the cymbalta to 60 and adding Prozac. What do u think of this idea. Or would it be best to just go for the TCA?
Re: Questions about meds?
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Originally Posted by
pokerfan
You mentioned that Anafranil is the most potent AD. What does this mean exactly. I guess my question is what makes it more potent?
How strongly it binds to receptor, or transporter molecules. Anafranil binds to the serotonin transporters as well as all but most potent SSRI, paroxetine (Paxil), but is also a very potent inhibitor of norepinephrine/noradrenaline reupatke through its main metabolite.
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When i was on zoloft i had a bit of an issue with delayed ejaculation. That has pretty much gone away with the cymbalta. her thought was this might mean that i am lacking a bit on the serotonin part of the snri.
Hmmm. Just about every antidepressant attracts the same complaint so I wouldn't read to much into this.
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Since my family has had some success with Prozac she thought we might try dropping the cymbalta to 60 and adding Prozac. What do u think of this idea. Or would it be best to just go for the TCA?
I'm not a fan of poly prescribing. Why take two meds when one should be capable of doing the job? It is sometimes necessary, but it should be among the last options. Secondly, you've now had two SSRIs and one serotonin biased SNRI poop-out so adding another SSRI is likely to be a long shot, imho.
In fact, on reflection, I think a norepinephrine reuptake inhibitor such as the TCAs nortriptyline (Pamelor) and desipramine (Norpramin) and the SNRIs milnacipran (Savella) and levomilnacipran (Fetzima) should also be on the list of alternatives with Anafranil and Tofranil). Anafranil would still be my top pick, followed by either nortriptyline or desipramine.