[jess18]

Thinking about trying one. I used to be on an SSRI Lexapro and that worked well, but do the SNRIs help pain as well? Do they help with pain and also depression? Any suggestions to a good SNRI? I know Cymbalta is one, but I have not heard alot of positives on that one.

thanks jess

[mrsD]

SNRIs include: They are mixed and have some SSRI actions.
Effexor
Cymbalta
Savella -- this one is higher in SNRI functions

Cymbalta can cause liver damage. All of them can raise blood pressure.

There is a pain loop in the brain that involves certain tracts in the brainstem and trigeminal nerve system. Serotonin and norepi are involved in this loop. It is thought that increasing serotonin and norepi for some patients increases inhibitory actions and prevents the pain from "taking hold" or becoming a fixed response.

Because Savella is new in US not much is known here about discontinuance problems. The other two have significant discontinuance issues. Savella has been in Europe and Japan for quite a while now. It is being recommended for fibro patients.

Can't say how you will react. You'll just have to try it.

I personally think Cymbalta is too problematic.

[johannakat]

i just started savella and stopped effexor...jury is still out, i have had a rough tcouple weeks, so not sure if the savella doesn't work as well or if i just haven't adjusted to not having the effexor.

I can say that though effexor made me gain weight, it was GREAT for mood and pain control for me. I ended up takign the lowest dose of effexor along with wellbutrin for a year or so now. I'll give savella another few weeks before if i decide going back might be the thing to do.

I am also curious about pristiq. It is marketed for menopause, but i think it is similar to savella. Mrs D do you know anything about that?

Originally Posted by mrsD

SNRIs include: They are mixed and have some SSRI actions.
Effexor
Cymbalta
Savella -- this one is higher in SNRI functions

Cymbalta can cause liver damage. All of them can raise blood pressure.

There is a pain loop in the brain that involves certain tracts in the brainstem and trigeminal nerve system. Serotonin and norepi are involved in this loop. It is thought that increasing serotonin and norepi for some patients increases inhibitory actions and prevents the pain from "taking hold" or becoming a fixed response.

Because Savella is new in US not much is known here about discontinuance problems. The other two have significant discontinuance issues. Savella has been in Europe and Japan for quite a while now. It is being recommended for fibro patients.

Can't say how you will react. You'll just have to try it.

I personally think Cymbalta is too problematic.

[mrsD]

Pristiq is just a variant on Effexor. It is therapeutically the same IMO. Effexor has a very short half life, so they diddled the molecule to make it more potent.

The Savella has less SSRI actions I believe than Effexor. That is what you are probably feeling.

The conference I attended made a reference to the norepi system being stronger in some pain responses. So Savella is an option for that. But it can raise blood pressure. So far it does not have the liver warnings that Cymbalta has.
But it can alter liver functions some:

In the placebo-controlled fibromyalgia trials, increases in the number of patients treated with Savella with mild elevations of ALT or AST (1-3 times the upper limit of normal, ULN) were observed. Increases in ALT were more frequently observed in the patients treated with Savella 100 mg/day (6%) and Savella 200 mg/day (7%), compared to the patients treated with placebo (3%). One patient receiving Savella 100 mg/day (0.2%) had an increase in ALT greater than 5 times the upper limit of normal but did not exceed 10 times the upper limit of normal. Increases in AST were more frequently observed in the patients treated with Savella 100 mg/day (3%) and Savella 200 mg/day (5%) compared to the patients treated with placebo (2%).

The increases of bilirubin observed in the fibromyalgia clinical trials were not clinically significant. No case met the criteria of elevated ALT > 3x ULN and associated with an increase in bilirubin ≥ 2x ULN.

There have been cases of increased liver enzymes and reports of severe liver injury, including fulminant hepatitis with milnacipran from foreign postmarketing experience. In the cases of severe liver injury there were significant underlying clinical conditions and/or the use of multiple concomitant medications. Because of underreporting, it is impossible to provide an accurate estimate of the true incidence of these reactions.

from http://www.rxlist.com/savella-drug.htm

As time passes, we should know more about it.

Cymbalta's damage is worse IMO so far.

[DevaMaia]

Originally Posted by jess18

Thinking about trying one. I used to be on an SSRI Lexapro and that worked well, but do the SNRIs help pain as well? Do they help with pain and also depression? Any suggestions to a good SNRI? I know Cymbalta is one, but I have not heard alot of positives on that one.

thanks jess

I would not recommend taking antidepressant after a while they do not work anymore. I had patients come for depression who were on antidepressants for many years. What is needed is a change of lifestyle with exercise. Many studies show that exercise work better than antidepressants. Raw food nutrition and amino acids should help to balance brain neurotransmittors. Examine your issues, fear, hopes with the help of a psychologist. This is a lot. Start educating yourself .

[mrsD]

Hello Deva....

The use of antidepressants in chronic pain management is a bit different than for depression.

Here is a discussion of this pathway:
http://www.wellcome.ac.uk/en/pain/mi.../science2.html

[lexiemae1]

Originally Posted by mrsD

SNRIs include: They are mixed and have some SSRI actions.
Effexor
Cymbalta
Savella -- this one is higher in SNRI functions

Cymbalta can cause liver damage. All of them can raise blood pressure.

There is a pain loop in the brain that involves certain tracts in the brainstem and trigeminal nerve system. Serotonin and norepi are involved in this loop. It is thought that increasing serotonin and norepi for some patients increases inhibitory actions and prevents the pain from "taking hold" or becoming a fixed response.

Because Savella is new in US not much is known here about discontinuance problems. The other two have significant discontinuance issues. Savella has been in Europe and Japan for quite a while now. It is being recommended for fibro patients.

Can't say how you will react. You'll just have to try it.

I personally think Cymbalta is too problematic.

I thought I was just crazy thinking Cymbalta was causing alot of my problems all I ever hear my doctor say is Cymbalta is such a good drug!! I wondered about this when my hair started falling out by fingerfuls.

[jess18]

Deva
My husband would think that I educate myself too much. I have a nutritionally sound diet, and exercise by walking, swimming etc.. and have a healthy lifestyle, vitamin supplementation etc. Certain illnesses and accidents are not under our control.
As Mrs D pointed out low doses of antidepressants are used for chronic pain not depression, and I am researching at the moment.

thanks

[DiMarie]

Originally Posted by jess18

Thinking about trying one. I used to be on an SSRI Lexapro and that worked well, but do the SNRIs help pain as well? Do they help with pain and also depression? Any suggestions to a good SNRI? I know Cymbalta is one, but I have not heard alot of positives on that one.

thanks jess

I found Lexapro is the ONLY one I would recommend, had good results with and actually works.
I tried everything except Cymbalta because of what I heard.
The cost is going to be difficult being on medicare and Plan D, it will be a tier item that would cost me $75 a month mail order at @ 2 $150.00
BUT Canada is the only one the PCP will allow me to purchase from is $88 for three months supply.

I did have to titer up because of insomnia and loss of appitite, It took about 4 weeks and I got to 20 mg. One extra side help, is my Rosecea is completly gone on the 20 mg, the pain flares are reduced. My mind does not work mulling over my sadness and conflicts in life.

So I don't know how I will do it, but It took me 9 months to detox all the nasties on effexor, the horrid nightmares, weight gains, the feeling that I am spending money and the problems are not manageable from the medication.

It will be about 2 years in the US until the generic is avaiable, but in CA it is availble now.

I just need the $88 asap so I am not short, I tried to cut in half and it is not working out.
di

[RoyC2011]

Anyone know of a safe for Lyme Disease anti Depressant???