Hi,

Alan is on plavix, aspirin, metoprolol (since his stent) and zoloft, for his depression.

He tried the lyrica (but his ankles blew up). so he's off the lyrica, He can't take neurontin or elavil, got him deathly sick.

So most recently Alan was given samples of Cymbalta (for the nighttime PN pain). Well, it is working. The lower dose was only a bit helpful, the higher dose is working just fine.

Dr. Fred told Alan he could take the higher dose because he's having the spinal tap and he is afraid the pn will flare up when he has to lie down for 4 hours.

Now here's my question.


If Cymbalta is actually an anti-depression med, and Alan is already on Zoloft (I did ask this of Dr. Fred but he assured me that Alan can take both), my question is "how can someone take two different anti-depression meds".

Alan wakes up every morning and goes to the gym or does yoga.

I asked him yesterday morning, "why not stay home and relax and he said "are you kidding, I had a great night's sleep and I have this energy and I have to exercise it off".

He has energy????? He's almost 60. Where is he getting this energy???

I look like Quazimodo during a sciatica attack and this guy wants to learn to stand on his head. If it wasn't for the PN, he'd be perfect.

Is it the combination of the Cymbalta and Zoloft that is giving him the stamina to do this stuff. He got up at 6 a.m. to go into the city to some seminar. I mean, I lost tons of weight too, but I don't jump out of bed and and I'm not raring to go, (at least not until I have my coffee).

I thought a person could not mix medications. And I never thought a person could take cymbalta, zoloft, (and oh yes, he still takes the alprazolam at night to sleep). At least I think he does.

So he gets a real deep sleep and wakes up raring to go.

I can't wait to see how he's going to be at 70. He'll outlive me.

Melody

Using Cymbalta WITH Zoloft.

I would think the Zoloft could be dropped.

Cymbalta can raise blood pressure, and that should be monitored.
http://www.healthyplace.com/medications/cymbalta.asp

Taking them both together may cause serotonin syndrome.
Since Cymbalta is a potent antidepressant, why would anyone need
another SSRI ?

http://www.pdrhealth.com/drug_info/r.../cym1693.shtml
Because Alan had the reaction to Celebrex-- watch for allergic reactions
with him on the Cymbalta:
http://www.healthyplace.com/medications/cymbalta.asp

You need to discuss why both antidepressants..are needed with the doctor.
Keep in mind that non-psychiatric doctors don't understand SSRI drugs
very well.(or at all)

Well, when Dr. Goldfarb gave Alan the samples of Cymbalta, I, right off the bat said "wait a minute, he's on zoloft, isn't that a contradiction" and she said "no, don't worry, he's taking this dose for nerve pain".

So far Alan is fine as a clam, no adverse affects. He gets liver function tests all the times. He sees Dr. Fred all the time. They discussed the Cymbalta and Dr. Fred was fine with it.

So what am I supposed to look out for?

When we go to see Dr. Fred (end of the month), should I ask if Alan should be off the zoloft. I mean, I DID ASK THESE QUESTIONS, but both Dr. Goldfarb and Dr. Fred are not worried.

And Alan is doing splendidly, going to the gym, learning yoga, becoming more flexible, (and the depression seems to be gone, thankfully).

So far it's all GOOD.

He's been on Cymbalta for over 2 weeks now. Been on zoloft for almost 10 months.

Anything I should do? jeez. If I could be reborn, I want to come back as a man and have me for a wife!!!!!

Oh, I know what I'll do, when I fax Dr. Fred asking about the insulin level thing, I'll just pop in a question about the cybalta and the zoloft. That's good, right?

There are like 11 different serotonin receptor subtypes and different antidepressants work on a different mix of the receptors. That and also the receptors downregulate anyways.

You said this:

"There are like 11 different serotonin receptor subtypes and different antidepressants work on a different mix of the receptors. That and also the receptors downregulate anyways."


Now (not that I understand everything you said), but I gather I can translate this into the following:

"There are 11 places in the brain that react differently to different anti-depressants. So some parts of Alan's brain are reacting to the Zoloft, and the other parts of Alan's brain are reacting to the Cymbalta.

Now the part about receptors downregulate anyways, (I HAVE NO IDEA WHAT THIS MEANS).

Care to elaborate???

much hugs.

melody


I JUST LOOKED UP SEROTONIN SYNDROME: (by the way, Alan takes 100 of the zoloft (in generic form) one time a day and 60 of the cymbalta (one time a day).


Serotonin syndrome is a rare, but potentially life-threatening adverse drug reaction that results from intentional self-poisoning, therapeutic drug use, or inadvertent interactions between drugs. It is an iatrogenic (i.e. caused by medical treatment) toxidrome. It is most commonly referred to as serotonin syndrome, however, serotonin toxicity or serotonin toxidrome (from toxic + syndrome) is more accurate as it reflects the fact that it is a form of poisoning.[1][2]

Serotonin syndrome is not a spontaneous drug reaction, it is a consequence of excess serotonergic activity at central nervous system (CNS) and peripheral serotonin receptors. This excess serotonin activity produces a specific spectrum of clinical findings which may range from barely perceptible to fatal.[3]
It also mentioned the combination of different drugs and foods. talked about tryptophan (so no turkey for Alan I gather).
This stuff obviously didn't concern the doctors but it sure as hell scares the crap out of me. (sorry for the bad words).

I drafted a fax for Dr. Fred. Both Dr. Fred and Dr. Goldfarb are not in their offices today (closed)
Hopefully Alan will run into Dr. Fred at the gym tomorrow.

I shall ask him to have a talk on this with Dr. Fred.

jeez. just more stuff.

But Alan doesn't exhibit any of the symptoms it gave in the article. That much I know.


OH JUST SO EVERYBODY KNOWS ONE THING ABOUT ALAN, HE NEVER TAKES ONE SIP OF ALCOHOL.
NEVER......Even at a wedding, or party. He used to drink as a young man and I'm married to him for over 26 years, and he only drank at one party, got deathly drunk and never did it again

So no alcohol at any time.

http://en.wikipedia.org/wiki/Serotonin Look at the receptor list. There are some in the PNS, the CNS, blood vessels, all over the body. Some work on certain receptors more than others.

Receptors downregulate in number due to an excess in signaling. If you take an excess of an SSRI, the receptors downregulate to get back to normal. It's like if you take caffeine, you need more to get a stimulant effect after awhile since the receptors downregulated.

Well, your quote Mel says it all:
In other words...caused by doctors.

Who is to say that raising Zoloft to 200mg a day (rather a lot) would be
any different? Who is to say that Alan might have some autonomic neuropathy, and would not display some of the symptoms? Like sweating..which would be
first to see.

Who is to say he might develop hypomania as a side effect of too much SSRI activity?

Cymbalta is very like Effexor. It has serotonin reuptake actions as well as
NOREPINEPHRINE ones. It is an ANTIDEPRESSANT and is only favored by
doctors for PN because LILLY did studies to push it that way to make more
money. It is still an antidepressant in all other ways, and does not shed those
actions just because "it is for PN".

This quote's logic eludes me:
And in MY world, many older patients are titrated UP with Cymbalta. Starting at 20mg a day. Here Alan is given the highest dose right off the bat?
60mg is the highest dose they make!

And you are worried about a little turkey now and then?
here is a nutrition website with tryptophan content in foods...it is by calories...hence spinach is high, but who eats 200 cal of spinach? That would be a ton. But compared to fish, turkey is about equal.
http://www.nutritiondata.com/foods-0...0000000-1.html
just about all protein foods are fairly good sources of tryptophan.

What to look for?
http://uuhsc.utah.edu/poison/healthp...x/Vol4_No4.pdf

It may never happen. Then again it may. What is for sure, getting off both,
in the future will be problematic and require careful tapering.

Given Alan's style of functioning you probably will only see dramatic symptoms.

One thing excess serotonin does, is increase bleeding. So do not use any
NSAIDS, for pain. There are warning for this.

The vast majority of serotonin's actions are in the body, not the brain. It is there that the syndrome manifests, mostly because of that.

I think the first symptoms you may see in Alan involve sleeping issues. Since benzos block serotonin syndrome symptoms, I would
be concerned if his old dose of Xanax doesn't work anymore.

Mrs. D. Alan didn't start the Cymbalta at 60.

He started two weeks ago (with Dr. Goldfarb) at 30, She said "after two weeks, you go to 60". That's what he did.

So I gather you don't think this taking of the two anti-depressants is a good thing.

Well, now I'm practically in crisis mode. I can't reach anybody. Alan is fine. Just came home from being in NYC all day and feels fine, ate a good dinner and is sitting down having tea and a muffin.

He displays no symptoms. But I do understand that you are saying "he just might someday display these symptoms".

Monday, I'll call Dr. Goldfarb's office and tell her what I learned about Seratonin Syndrome. I'll also do the same when I fax Dr. Fred.

Honestly, I don't know what else to do. We see Dr. Goldfarb and Dr. Fred at the end of the month.

I mean, is this thing a definite here. I'm getting a bit paranoid. Idon't know what to do. Alan is nonchalant about the whole thing. He says "if my doctors know about this and we did ask them, and they said I could take it, well, I trust them".

Also, Mrs. D. you said "Given Alan's style of functioning you probably will only see dramatic symptoms"

Not sure what you mean by this!!!!

So what's a wife to do now?????

mel

This is a board for information. No one can tell you what to do Mel.

But being aware and prepared is always a good thing.

We discussed this on another thread...that Alan does not communicate
physical feelings easily. You agreed with this. This is a style for him.

Patients like this are difficult for doctors. Someone else might go in there and
gripe...I have diarrhea... I feel antsy...I can't sleep...etc etc.

Alan has you to massage him, give him the best diet, and advocate for him.
That is pretty rare these days!

How to ask the questions you are posing? Well ask if the doctors think 200mg of Zoloft are necessary? That is approximately what he is getting now with this combined therapy (it may be higher in an additive sense).
Also realize that people are at the mercy of post-marketing situations, where drugs are combined. Many reactions may go unreported..and do.
And realize that a psychiatrist is not monitioring Alan. A psychiatrist usually has more experience with combining drugs of the same class.

Doctors don't realize that Cymbalta is nothing but Effexor...a me-too drug.
The only difference is that it was cleverly posited to the neuro community for pain control. And you may see with some time, maybe a couple of months, Alan reaches a ceiling in benefit, and is back to where he started ... that is common too. ( and if this happens, he cannot cold turkey off it...must taper)
What can you do? Well, you watch him carefully. And you watch those doctors too!

Thanks Mrs. D. for all the information.

I will run everything by his doctors and update on these boards.

Oh, by the way. Alan read the post. He said to me "why do they think I don't communicate with the doctors?" "I just don't like to post on the boards, but I talk to all my doctors".

I laughed and said "who massages you?" He smiled and said "you got me there".

But I told him from now on he has to take a more hands on approach when we go on appointments. I mean, what if something happens to me?. He agreed. So he goes on Monday for the pre-testing (he doesn't need me for that) and I'll be there with him for the spinal tap (for support in the recovery room). He is taking a more pro-active approach in his health (losing weight, exercising, yoga, etc.)

I have to put me first sometimes too and he understands that. We are really going through a very hard time with our son being mentally ill and being so far away. Sometimes it's surreal what we have been through.

Some days we deal with it, some days we walk around and go "why".

But we shall get through this also. We always do.

Thanks much.

Melody