Which anti depressants combine well with Lyrica?

[akb]

Hi there

I'm on 200 gm Lyrica and 30 gm Cymbalta but anxiety still bad. Also a klonopin in the afternoon.

Mirtazapine seems to combine well but I couldn't get through 3 days of side effects. So am looking for an AD substitute. Or should I just increase the Lyrica?

I don't have a doctor

[panic_down_under]

I'm on 200 gm Lyrica and 30 gm Cymbalta but anxiety still bad. Also a klonopin in the afternoon.

Mirtazapine seems to combine well but I couldn't get through 3 days of side effects. So am looking for an AD substitute. Or should I just increase the Lyrica?

Why not increase the Cymbalta? You're on what is a sub therapeutic dose for most. Not only is that pointless, but taking sub therapeutic doses for extended periods may increase the risk of the med not working even at higher doses. Also be aware there is good evidence benzodiazepines inhibit the mechanism by which antidepressants work, so it would be good to wean off the Klonopin as soon as you're able to.

I don't have a doctor

Then I urge you to get one asap.

[akb]

Hi PDU

I agree with what you say.

I was on 90 mg of cymbalta before and it wasn't working. The klonopin is the only thing that seems to do anything positive. 0.5 mg

I don't have a doctor because I'm in a third world country jail which doesn't have one. I get my meds sent to a religious pastor who brings them in for me.

akb

[panic_down_under]

I was on 90 mg of cymbalta before and it wasn't working.

So are you tapering off Cymbalta, or holding at 30mg until you find something else?

I don't have a doctor because I'm in a third world country jail which doesn't have one.

This complicates things as there's no gatekeeper to block anything that might be inappropriate for you.

Do you have any known health issues apart from anxiety, in particular heart disease, or diabetes? Also how old are you?

You could try increasing the Lyrica dose, but frankly I'm not a fan. It seems to work okay for some, but not that well for most and in the longer term I'm not convinced it will prove to be any better than the benzodiazepines.

Have you been on any other antidepressants apart from Cymbalta and mirtazapine? If so, did any of them have a positive impact, even if not completely effective.

Also, given the circumstances, what meds do you have access to?

[hanshan]

Hi P.D.U.

Have you seen the NMP poll for pregabalin? It's only a small group of people responding who are self-selecting, but when asked if they found pregabalin helpful, the answers were (converted to percentages)

Yes - 53%
Only a little - 22%
No - 7%
Undecided - 18%

Those are pretty good results. 75% of respondents found pregabalin helpful to some extent, and only 7% were a definite no. I think those results would be comparable or superior to most antidepressants.

Also, I'm not sure - have you taken pregabalin yourself? The last time I checked, it wasn't PBS listed for anxiety as it is in the UK and EU, so Australians have to pay the full price to take it for anxiety, which makes it expensive (maybe up to five or six dollars a day, depending on dosage). Unlike benzodiazepines, its response is not immediate and somewhat muted, but it can be taken on a regular basis over an extended time as a maintenance medication, which I think gives it an edge over benzodiazepines for people who have continual low-level anxiety.

[panic_down_under]

Also, I'm not sure - have you taken pregabalin yourself?

No. I did try gabapentin, the less bio-available predecessor to pregabalin, some time ago. Apart from side-effects it did nothing even at 3,600mg/day. And this accords with most of the anecdotal evidence from people that have tried it or pregabalin in the support groups I've been active in. A few do well on pregabalin, most end up switching to something else. Even here many seem to be supplementing it with mirtazapine which suggests it isn't that effective.

The last time I checked, it wasn't PBS listed for anxiety

It has been considered by the PBS panel a number of times and been rejected for anxiety. I assume they are not yet convinced by the data presented.

which I think gives it an edge over benzodiazepines for people who have continual low-level anxiety.

Imho, mild/low-level anxiety is best treated with cognitive/behavioral/mindfulness therapy when available, not meds.

[akb]

Hi Hanshan

Thanks for your reply.

Are you saying that pregabalin is only good for low level anxiety?

Akbar

---------- Post added at 03:31 ---------- Previous post was at 03:22 ----------

Hi PDU

What you say makes sense. I am still unsure whether pregabalin is helping.

What medication would you suggest for severe anxiety?

I do mindfulness and yoga every day, helps a bit.

Akb

[hanshan]

Pregabalin is rated 8.1 out of 10 for generalised anxiety based on 146 user reviews at Drugs.com.

https://www.drugs.com/comments/prega...-disorder.html

This is about as high an average rating as any medication gets on Drugs.com. 42% of respondents rated it 10 and 22% rated it 9. There are always the people who tell you its the worst medication on earth etc, but that happens for every med.

Pregabalin is approved for generalised anxiety in the UK and EU. Some doctors have been prescribing it for people with panic disorder. It may be helpful in restoring a general sense of calm and so reduce panic triggers, but other meds may be better at blocking a full-on panic attack.

My own experience is that after forty years or more of persistent generalised anxiety (and various meds and therapy) pregabalin stopped the GAD pretty much completely and immediately. I still get breakthrough anxiety, but at times when ordinary people would likely experience some anxiety.

[MyNameIsTerry]

Hi P.D.U.

Have you seen the NMP poll for pregabalin? It's only a small group of people responding who are self-selecting, but when asked if they found pregabalin helpful, the answers were (converted to percentages)

Yes - 53%
Only a little - 22%
No - 7%
Undecided - 18%

Those are pretty good results. 75% of respondents found pregabalin helpful to some extent, and only 7% were a definite no. I think those results would be comparable or superior to most antidepressants.
.

Only 55 have voted. I've never taken Preg but I can vote. The %'s are far less when you consider the small numbers involved.

There is no comparison to a clinical trial. Half those votes could be from anyone for all we know.

We can use anecdotes but suggesting they could provide superior drug information is obviously wrong.

---------- Post added at 05:46 ---------- Previous post was at 05:34 ----------

Escitalopram 7.9 for 1634 reviews.

It gets 8.2 for 352 reviews for GAD. Of GAD posters (since we have no controls here) we get 39% at 10 and 26% at 9. But that's meaningless without the true numbers which are 137 for 10 and 91 for 9. It was 65 and 34 for Preg.

Punching in Cit or Sert reveals a lower number overall but they have much higher review numbers than Preg, this can reduce those averages. The devil will be in the detail in terms of the 9 & 10 voters but whether any of this is statistically significant should be considered.

Push up the voter numbers on Preg to match them and see if it has retained a higher rating. The numbers are much lower right now and that's going to reduce the spread of votes and influence those averages.

[flipp]

Hi pdu and hanshan I have just been prescribed Valdoxan it is very expensive and a private script, I was on Mirt and it was cheap also a benzo,would either of you know why it is so bloody costly?.