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cymbalta

Discussion in 'General Treatment' started by cb2, Oct 31, 2015.

  1. cb2

    cb2 Senior Member

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    Hi
    i am tapering off effexor and adding cymbalta..both very low doses ...dr has me adding 10mg of cymbalta then after a week increase to 20. i have only been taking the 10mg for 2 days but i have noticed i am more "zombified" during the day.. tired and feeling like i just can't wake up .

    will this wear off as i get more used to the cymbalta? with the effexor it used to give me energy during the day then i noticed it was causing tireness so i started taking it at nite instead of the morning. I am wondering if cymbalta is similar?

    thanks
     
  2. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

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    Like you, I've been on Effexor and found it gave me energy during the day, but it never caused me to be drowsy, so I never switched to night-time use.

    I've heard Cymbalta can go either way with people. For some it will make them drowsy, for some it will be stimulating. I found it made me slightly drowsy, so I started taking it around 6 p.m. At one time I had worked up to 40-50mg/day.

    I've tried a lot of different antidepressants and when I wasn't sure whether one would keep me awake or make me drowsy, I took my first dose in the morning on a day when I didn't have anything planned and gradually increased the dose from there. I didn't notice much with 10 mg of Cymbalta, but like you I started feeling a bit more drowsy at 20mg. The effect you DON'T want is to take a medication in the evening that ends up keeping you awake - it's much easier to manage a small amount of sedation during the day and move the dose to night-time.

    I never reached the point of feeling zombified on Cymbalta, and you may be more sensitive to it than I am. It could be that you'll feel a lot better by taking the dose at night-time.

    One thing to be aware of: tapering off any antidepressant can cause discontinuation syndrome, and when I've had that it will lead to headaches, nausea and fatigue, almost feeling like I have the flu. You want to be sure you're tapering off Effexor very slowly. If you're not sure how slow that should be, your doctor should be giving you advice on that.
     
  3. charles shepherd

    charles shepherd Senior Member

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    Info from the MEA Information leaflet on Cymbalta/duloxetine:


    DULOXETINE/CYMBALTA FOR FIBROMYALGIC AND NEUROPATHIC PAIN RELIEF


    What is Duloxetine?


    Duloxetine (trade name = Cymbalta) is a drug that has several uses. It is normally used to treat more severe cases of depression. But it is also sometimes used to treat a generalised anxiety disorder and for stress incontinence. It can also be helpful for pain relief.


    Duloxetine acts by normalising an imbalance in two important brain chemical transmitters - noradrenaline and serotonin - that can occur in depression.


    In relation to stress incontinence, this is often caused by a weakening of the pelvic floor muscles following childbirth. This results in episodes of incontinence following coughing, sneezing or exercise. Duloxetine (trade name here = Yentreve) is sometimes used to treat stress incontinence where pelvic floor exercises have failed to adequately help. The drug acts by helping the muscles around the bladder outlet to contract more strongly.


    How does duloxetine help with pain?


    As with other some types of antidepressant medication - low dose amitriptyline for example - duloxetine has been shown to help some people with pain, including both neuropathic/nerve pain and fibromyalgic pain.


    Neuropathic pain is often described as a more severe or intense type of pain that is burning, shooting and stabbing and can keep people awake at night. Duloxetine can also be used to treat diabetic neuropathy - where nerve damage causes pain in diabetes.



    In the case of pain relief, duloxetine may be acting by calming down parts of the central nervous system that are involved in the transmission and assessment of messages about pain and altering the way in which the brain responds to these messages about pain.


    Fibromyalgia (FM) is a condition that has a number of overlapping symptoms with ME/CFS and produces tender spots in various specific locations around the body - often on both sides in a symmetrical pattern. Some people with ME/CFS have what can be described as a fibromyalgic pain component to their illness and some doctors see no real difference between FM and ME/CFS. So there is a considerable degree of symptom and diagnostic overlap between FM and ME/CFS.


    Consequently, where there is evidence that a drug can be a safe and effective option in FM, as is the case with duloxetine, it could also be of value for some people with ME/CFS. Like gabapentin and pregabalin, duloxetine is therefore an option for pain management that your doctor may decide to consider.


    Are there any contra-indications to taking duloxetine?


    Duloxetine should not be used, or only used with caution, in the following situations:


    • pregnancy or breast feeding - as is the case with any antidepressant drug

    • liver, kidney or heart problems, including high blood pressure

    • glaucoma

    • mania, mood swings or bipolar disorder

    • seizures/fits

    • blood disorder that increases the risk of bleeding


    Duloxetine can interact with other drugs, including over-the-counter and alternative remedies such as St John's Wort, where it increase the risk of side effects occurring.




    Does duloxetine have any side-effects?


    As with all antidepressants, duloxetine has side-effects – some of which are symptoms that are found in ME/CFS. So the side-effect profile clearly has to be taken into consideration when considering making use of this drug to manage pain.


    Common side-effects can include headache, drowsiness, nausea, constipation, dizziness, blurred vision, and dry mouth.


    If it causes dizziness or sleepiness, do not drive or operate machinery.


    · Nausea can be reduced by eating simple meals and avoiding spicy foods.

    · A dry mouth can be eased by chewing sugar-free gum or sucking sugar-free sweets.

    · Constipation can be reduced by drinking plenty of water and a cautious increase in fibre intake.


    People who experience any form of depressing or distressing/suicidal thoughts whilst taking duloxetine must speak to their doctor as soon as possible.


    Less common side-effects include muscle pains and twitchings, impaired temperature regulation, vertigo (spinning round sensations), loss of appetite, flushes, raised blood pressure, feeling anxious, feeling shaky, increased sweating and loss of interest in sex.


    How is it taken?


    The drug is taken in capsule form - normally once a day at the same time. The capsules should be swallowed with a glass of water.


    There is a lower (30mg) and higher (60mg) strength capsule available. As people with ME/CFS are often very sensitive to drugs that act on brain chemical transmitter systems, it is sensible to start with a low dose and gradually increase the dose.


    If a dose is forgotten this should be taken as soon as possible. If it is missed till the following day do not take two doses together to compensate.


    Are there any other considerations or warnings?


    As with any antidepressant drug, it may take a few weeks before any real benefits occur and start to build up. So it should not be abandoned after only a week or so because no obvious benefit has occurred.


    Duloxetine should not be discontinued abruptly. There should be a gradual reduction in dose over several weeks to prevent withdrawal symptoms.


    Have there been any clinical trials to assess its use in fibromyalgia and ME/CFS?


    A number of clinical trials have assessed the use of duloxetine in FM and new study from Japan adds further support for its use as an option for treating fibromyalgic pain.


    The Japanese clinical trial was a randomised, double-blind, placebo controlled phase 3 study where one group of FM patients received duloxetine (n =196) and the other group (n=197) received a placebo.


    The trial demonstrated a significant improvement in the change of average pain scores from baseline to week 14 and improvement in overall quality of life.


    Duloxetine was generally well tolerated in this trial with somnolence, nausea and constipation being the most common side effects.


    Reference:

    Murakami M et al. A randomized, double-blind, placebo-controlled phase 3 trial of duloxetine in Japanese fibromyalgia patients. Arthritis Research and Therapy, 2015, 17, 224.


    Full paper available here:

    http://www.arthritis-research.com/content/17/1/224


    In relation to ME/CFS, Arnold et al (see boxed abstract) have reported on a randomized, double blind trial that compared duloxetine with a placebo. Whilst the drug had no significant effect on fatigue, there were benefits in relation to pain, mental fatigue and a global measure of severity. Duloxetine was generally well tolerated in this group of patients.


    Is there any patient feedback?


    As with any drug that is used in ME/CFS or fibromyalgia, there are numerous reports on internet forums – including MEA Facebook - from people who have been prescribed duloxetine. As is often the case, there are reports from people who have found this drug helpful, sometimes very helpful. Others have found duloxetine to be of no benefit or have discontinued it due to side-effects. A small number report that they have been made significantly worse after taking this drug.


    Conclusion:


    This is a drug treatment option that could be considered for some people who have a diagnosis of FM, or in the case of ME/CFS where there is a fibromyalgic or neuropathic component to pain, especially if there is significant co-existent clinical depression that requires drug treatment as well. Further clinical trials would be useful to obtain a better guide as to which people with ME/CFS might benefit and which do not.

    ________________________________________


    BOX: Abstract from ME/CFS clinical trial carried out by Arnold LM et al:


    Psychosomatics. 2015 May-Jun; 56(3): 242-53.


    A randomized, placebo-controlled, double-blinded trial of duloxetine in the treatment of general fatigue in patients with chronic fatigue syndrome.



    OBJECTIVE:

    To assess the efficacy and safety of duloxetine in patients with chronic fatigue syndrome.


    METHODS:

    A 12-week, randomized, double-blind study was designed to compare duloxetine 60-120 mg/d (n = 30) with placebo (n = 30) for efficacy and safety in the treatment of patients with chronic fatigue syndrome. The primary outcome measure was the Multidimensional Fatigue Inventory general fatigue subscale (range: 4-20, with higher scores indicating greater fatigue). Secondary measures were the remaining Multidimensional Fatigue Inventory subscales, Brief Pain Inventory, Medical Outcomes Study Short Form-36, Hospital Anxiety and Depression Scale, Centers for Disease Control and Prevention Symptom Inventory, Patient Global Impression of Improvement, and Clinical Global Impression of Severity.

    RESULTS:

    The improvement in the Multidimensional Fatigue Inventory general fatigue scores for the duloxetine group was not significantly greater than for the placebo group (P = 0.23; estimated difference between groups at week 12 = -1.0 [95% CI: -2.8, 0.7]). The duloxetine group was significantly superior to the placebo group on the Multidimensional Fatigue Inventory mental fatigue score, Brief Pain Inventory average pain severity and interference scores, Short Form-36 bodily pain domain, and Clinical Global Impression of Severity score. Duloxetine was generally well tolerated.

    CONCLUSION:

    The primary efficacy measure of general fatigue did not significantly improve with duloxetine when compared with placebo. Significant improvement in secondary measures of mental fatigue, pain, and global measure of severity suggests that duloxetine may be efficacious for some chronic fatigue syndrome symptom domains, but larger controlled trials are needed to confirm these results.

    _____________________________________________________


    Dr Charles Shepherd

    Hon Medical Adviser, MEA
     
  4. cb2

    cb2 Senior Member

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    thank you @ cfs for 19 years and charles shepard. I am not sure if going to cybalmta is the right route for me.. i dont have much nerve or body pain.. mostly fatigue. time will tell i guess. thanks!
     
  5. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

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    Cymbalta had a small effect on my neuropathic pain, but had no effect on fatigue or anything else.
     
  6. SOC

    SOC Senior Member

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    Similar here. Cymbalta helped with my ME-type pain, but did nothing for fatigue or any other ME symptoms. When I no longer had the pain, I quit the Cymbalta and none of my other symptoms changed in any way.
     
  7. SOC

    SOC Senior Member

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    This is telling. I wouldn't put much faith in this research.
     
  8. cb2

    cb2 Senior Member

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    i am perplexed as the effexor helped at first with energy- it helped alot- then it started making me tired. i have no idea what to do. my shrink thinks cymbalta is better than effexor and easier to come off of if i needed to change. so far on the effexor taper i have been doing ok..execpt some fatigue the past couple days but i over did it this week with appointments and things that were necessary. maybe it isn't worth it to try to add in the cymbalta?
     
  9. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

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    In the long run you need to decide if cymbalta is doing any good for you personally. Whether one drug or another has a better discontinuation profile is to me, secondary, although like your doctor said, cymbalta is easier to come off of. A rule of thumb I've heard is that when you are trying a new drug, you keep taking it and increasing the dose (with your doctor's direction) until it either a) starts helping you or b) you get side effects that you can't tolerate, including drowsiness.

    Effexor was a game-changer for me in terms of managing neuropathic pain and increasing energy, but now it causes palpitations and has NO effect on energy, so I'll probably never take it again. Cymbalta also now causes palpitations.

    Tricyclics such as doxepin and nortriptyline have been helpful for sleep and pain. Paxil is awesome for sleep as is seroquel, if you don't mind feeling a bit zombified during the day. I haven't found any antidepressant other than Effexor to be helpful for energy.

    If you're still looking for something to give you energy, I recommend the supplement PQQ. It makes some people wired, but it just makes me more alert.

    Some antidepressants have helped with different aspects of my care, but I'm wondering what effect are you seeking? Better sleep, less pain, more energy, all of the above?
     
  10. cb2

    cb2 Senior Member

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    I dont have much pain, when i do it seems to be only in my quads and that comes from exercising- so the effect i am looking for is energy.. and help depressing if it comes along this winter-
    i did try PPq a couple months ago i finished one or 2 bottles and i dont rememeber it helping for certain.. i am also trying to get thyroids optimized.
    this
    wondering what about samE? i was trying to do a search for it on the fourm but i didn't have any luck. thanks.
     
  11. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

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    To search for posts about sam-E: It can be a little tricky finding results for short or abbreviated words here, so try this: Go onto google and enter this search string:
    sam-e phoenix rising
    OR
    enter this exact search string:
    sam-e site:forums.phoenixrising.me

    For me, the results from PQQ were evident within a few days, so if you finished one or two bottles, I'd say it's not worth it to pursue it any further.

    I haven't come across any antidepressants that gave me energy, other than Effexor.
     
    cb2 likes this.
  12. cb2

    cb2 Senior Member

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    thank you @CFS_for_19_years i will work on a search with your methods mentioned above. good idea! thnak you.
    i have heard that wellburtin is good for energy but i didnt experience that .
     
  13. SOC

    SOC Senior Member

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    Very high dose (~2400mg) CoQ10 works for me, but it definitely doesn't for everybody. My ME/CFS specialist said their genetic testing is showing that many PWME have a genetic abnormality in which the conversion from ubiquinone to ubiquinol doesn't work well. So if you have ME/CFS it's worth trying ubiquinol instead of ubiquinone. Since it's supposedly at least 3 times as effective, you only need to take a third as much.

    FWIW, my specialist also suggested PQQ, but said the benefit is that it encourages the growth of new mitochondria, so don't expect overnight improvement. Two months might not be long enough to really tell if it's going to help.
     
  14. charles shepherd

    charles shepherd Senior Member

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    The limited amount of evidence (i.e. patient evidence, clinician evidence and evidence from clinical trials) suggests that this drug is going to be more helpful in reducing pain than fatigue. Of course, if you can reduce pain, then there may well be some improvement in fatigue levels. I think it is an option to consider where there is depression and fibromyalgic type pain.
     
  15. cb2

    cb2 Senior Member

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    thank you @SOC and @charles shepherd @SOC are you taking the 2400 of ubiquinol or the cQ10? there is a big difference in price..? are you using it for fatigue or? i found the puritian pride has the best price and someone told me their's is a good brand. I forget which PPQ i was using. any suggestions on a decent and cost affordable in those items? i ordered some sam-E to experiment with too. i have to be careful about not changing too many things at once- which i am too good at doing. : )
    also wondering how much the right thryoid levels may have to do with this? thanks everyone!
     
  16. SOC

    SOC Senior Member

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    I will PM you with the info. :)
     
  17. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

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    I've found PQQ to be a useful supplement to get rid of some brain fog. I don't take it after 12 noon or it will keep me awake.

    On the downside, some people have said it makes them feel speedy or wired. I've never had that problem, but I thought you should be aware of it.
    Of all the supplements I've tried, PQQ feels like it makes my brain function better and makes me more alert without any jittery feelings.

    Here are some inexpensive sources for you:
    https://www.swansonvitamins.com/swanson-ultra-pqq-pyrroloquinoline-quinone-20-mg-30-veg-caps

    www.amazon.com/Mind-Source-Naturals-Inc-Tabs/dp/B00BTNIJ0A (these are 20mg tablets)

    The great thing about the Source Naturals tablet is that you can cut them if you have a pill cutter handy. I feel some energizing effects even at 5 mg.
     
  18. cb2

    cb2 Senior Member

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    what about taking the coQ10 in the evening? can that keep one awake? i have heard different things, and since i can have sleep issues anyway, it is hard to know. thanks for the info!
     
  19. cb2

    cb2 Senior Member

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    oh wow that is a great price on the swanson.. 2 bottles for $20~ ! is it as good as the other?
     
  20. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

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    I think you'll have to come to your own conclusions regarding which brand of PQQ is best. People here are sensitive to different brands for every reason under the sun. Both products have great reviews.

    Keep in mind that 20mg may be too much for a lot of people here. If you buy the 20mg Swanson capsules and find they make you too jittery, you'll have a hard time fiddling with the capsules to get the right dose. On the other hand, if you buy the 20mg Source Naturals tablets and 20mg makes you too jittery, you can at least cut them into halves or quarters with a decent pill cutter (they aren't scored).

    My advice: Buy the Source Naturals tablets to start, and see if you can handle 20mg. If you can handle 20mg OR if Source Naturals doesn't seem to be working for you, then try the Swanson brand.

    I use Source Naturals because I need less than 20mg, most days it's 5 - 10mg. I don't take any at all on days when I get up late.
     

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