Duloxetine
 

I'm thinking of trying duloxetine ( cymbalta) for both pain and now awful anxiety and depression. Have any of you tried this and did you find it helpful for both the pain and depression ( for those affected by that also ).

Im taking 2700mg gabapentin and this is making me so spaced as it is - I don't want to feel worse from that perspective by adding to it.

I've taken Duloxetine for many years and it works for me.

However, we all react differently to medications, so trial and error is the only way to find out what works for you.

Hugs, ElaineD

My SFN came on last year in a wave of profound depression. I'm sensitive to SSRIs and SNRIs (Cymbalta is the latter; is said to be good for pain, but I couldn't tolerate it). I finally recently agreed to my neuropsychiatrist 's suggestion of lamotigine (Lactimal). It's an anticonvulsant...a sodium channel blocker that works very differently than SS or SNRIs.

It is used off -label for neuropathic pain, bipolar disorder, and unipolar depression (I'm unipolar).

It changed my life in the last month. It is a stabilizing drug, calming hyperactivity in neural channels, inhibiting glutamate. I titrated up from 25 to 100 mgs in six weeks and started feeling markedly better two weeks ago. The usual therapeutic dose is considerably higher...but I'll stay here for a while. It does not do a lot for my pain, which fortunately is tolerable. It's my dysautonomia that is bad.

Like all drugs that work on neural pathways, it is "dirty," and can have many side effects. One is Steven-Johnson's syndrome, a sometimes lifethreatening- rash.
However, all side effects are reduced if you slowly titrate up. I did have antidepressant effects immediately -- unlike conventional antidepressants. I can only suggest you read up on anything you are given. I have no side effects at all now..and I'm also sleeping better. Most importantly, my energy is up and I'm laughing a lot...in spite of having both autonomic and sensory neuropathy. The addition of depression had me thinking I would be an invalid for life.

It's really working for me, and my neurologist said just two days ago, it's a particularly good choice for SFN, for it apparently calms neuro-inflammation, which may be a cause of both SFN and depression. (Written with the caveat that autoimmune disorders might cause neuro-inflammation).

I hope the Cymbals works for you....don't give up hope if it doesn't...and go off very slowly if you change meds.

Best,
Sylvie

PS: gabapentin can cause depression! You might also consider nortriptyline.....a tricyclic AD which works well for pain and depression. It just enhanced my dysautonomic symptoms.

S

I hope it works for you and it is certainly worth an attempt if you and your provider both believe the potential benefits outweigh the risks. It is one of the approved drugs for diabetic neuropathy, I'm unsure about generally.

I didn't tolerate 30 mg well at all. I tried it for one month. My neuro felt I could benefit from the increased energy as fatigue is a big side effect of my neuropathy along with discomfort, pain and so on.

I'd describe the discomfort as a mental version of someone pushing me in the back of the shoulder saying, "hey, buddy". I did not like it, did not wish to pursue it further, though I have alsoread that plenty of others have had success.

The good old results may vary.

Best of luck,

Jon

Cymbalta
 

You are taking a large amount of gabapentin. I would try getting off that stuff.
Everyone is different. Here is my experience. I have PN due to a back injury. Tried gabapentin. Made me dizzy and felt spaced out all the time. Switched to Lyrica. Same kind of feeling. Neither gave more than 10 to 20% relief. A neurologist suggested Cymbalta, 20 mg. For me this gave the same level of relief as the others with absolutely no side effects as far as I can tell. I now only take it once in a great while if the PN is getting to me. I usually attempt to ignore it. I find that one 20 mg Cymbalta seems to last 2 days. Sometimes I feel better on the second day than the first! Wierd. It also seems to help regulate urination. Wikipedia says the manufacturer tried to get FDA approval for this use but was denied. So I am not just imagining this effect. You will probably find your depression goes away by stopping the huge amount of gabapentin.

Thanks Elaine. Having read all the responses, you are so right in that it is hit and miss depending on the person. It is great to hear that it has helped you though. Thanks as always for replying :-)

Hi Sylvie,

Its interesting you say this. I managed to get on relatively well with SSRI's years ago. I stopped for a number of years. (After I had my child my SFN hit and it went hand in hand with depression / severe anxiety at exactly the same time. I am convinced there is a physiological inflammatory cause behind feelings of depression.) I tried SSRI's again and I have now become hyper hyper sensitive since SFN hit. To the extent that after only one tablet on one day I vowed never to try it again. I was almost shaking under my duvet in bed in fear all day - it was bizarre. I'm therefore very cautious about any type of anti depressant but am desperate for something to help me through this. I feel alot of the depression is because of what has happened to me physically and I therefore feel like there is no point even trying to address the depression medically - but I have got to try something even if it is just a sticking plaster. If it helps numb the emotional anguish, I will try it.

I am going to look into Lactimal. I havent heard of this. My neuro and I both feel my SFN is inflammatory, if this affects neuro inflammation to some extent then this is worth considering. Thankyou for the reply, it is so helpful. :-)

I relate to what you said about being an invalid for life. I now actually recognise that the depression is becoming a significant beast in its own right and may be contributing more to my feelings of debilitation than I realised.

Hi User,

Thankyou for replying. I agree, the gabapentin dose is hefty. I was actually taking 3600mg but managed to wean down to 2700mg. I still experience significant pain and discomfort often despite this. I am terrified of what symptoms I will feel if I reduce the dose. I already fel like the medication is not enough to help me cope with the physcial pain. As you experienced, the gabapentin side effects are hard to tolerate. I am like a zombie and it is hell waking up every morning for my little boy. I have to lay there for about 30 to 45 minutes to come round. It is truly horrible but my options are limited at the moment.

It is really interesting to hear your experiences of duloxetine! Everyone has had such different experiences with this. I think it is great you arent taking gabapentin. It is a bummer to be stuck on this so if you really dont have to Id say that is for the best. Thankyou for the info, it is all really helpful.

[QUOTE=JoannaP79;1212540]Hi Sylvie,

Its interesting you say this. I managed to get on relatively well with SSRI's years ago. I stopped for a number of years. (After I had my child my SFN hit and it went hand in hand with depression / severe anxiety at exactly the same time. I am convinced there is a physiological inflammatory cause behind feelings of depression.) I tried SSRI's again and I have now become hyper hyper sensitive since SFN hit. To the extent that after only one tablet on one day I vowed never to try it again. I was almost shaking under my duvet in bed in fear all day - it was bizarre. I'm therefore very cautious about any type of anti depressant but am desperate for something to help me through this. I feel alot of the depression is because of what has happened to me physically and I therefore feel like there is no point even trying to address the depression medically - but I have got to try something even if it is just a sticking plaster. If it helps numb the emotional anguish, I will try it.

I am going to look into Lactimal. I havent heard of this. My neuro and I both feel my SFN is inflammatory,...


Hi Joanna,

Yes, I , my shrink, and my new neuro all think there is neuro-inflammation going on with Mr (especially with my acute onset of SFN and depression).. Lactimal (lamotigine) is especially good for this....I'm on my reader now and can't cut and paste, but there are good articles out there.. You can Google key words "lamotigine" and SFN, and separately lamotigine and depression. Apparently lamotigine not serotongeric at all...I've had no side effects so far (except edema..and there may be other reasons for this related to my autonomic neuropathy, which is also showing improvement)...as I wrote I titrated up 25 mgs every two weeks, and I plan to stay at 100 mg...less than half the usual therapeutic dose.

Read all about it.....I was really resistant to the idea, but I'm so glad I relented and tried it.

I'll be curious to see how it affects you if you try it!

S