And So Begins the Cymbalta Trial…

As I had discussed previously with my psychiatrist, we decided on Wednesday to put me on Cymbalta (Duloxetine). I took my first dose Wednesday night so that means I’m on my second full day of being on it. As with other SSRI/SNRI medications, it takes at least a week, but usually 2 – 4 weeks, to see any change. I think I’ve said this before but it bears repeating: I have little faith that Cymbalta is going to do anything for me. I think I just have a general tolerance to medications that work with serotonin, and perhaps norepinephrine. Maybe not norepinephrine, though; I did see a small (barely discernible, but apparent to the trained observer) change in my mood while I was on Effexor (Venlafaxine), which is an SNRI, so maybe I do respond a bit to norepinephrine inhibitors. Anyway the current plan is to take 30mg at night for two weeks, and then raise the dose to 60mg. My psychiatrist is prepared to go to 90mg if we don’t see any results after 3 weeks on 60mg.

Another thing we discussed on Wednesday was adjunct treatments; I’d been doing my usual research and had come across the name Abilify (Aripiprazole), an atypical antipsychotic that is also approved for treatment of Bipolar II and has recently been approved as an adjunct treatment for depression when used with another antidepressant. Abilify is specifically for people like me who haven’t seen any (or enough) effects from taking only one antidepressant. I’m not sure exactly how it works, but it sounds tempting. Another possible plus of Abilify would be that, as an antipsychotic, it may act like Risperidal (Risperidone) and control my verbal and motor tics, which would enable me to cut that medication out of my schedule. Cons of Abilify are:

– I would be taking yet another medication.
– It can cause insomnia, which would worsen an already horrible situation.
– It can cause shaking/tremors, which would make me even shakier.
– It can cause high blood sugar, and some people have developed diabetes while taking it (note that this was after long-time use – several years).
– It can cause speech disorders, which would complicate things because I already talk strangely because of my bruxism.
– It can cause permanent tardive dyskinesia. However, I’ve already been on Risperidone for about a year and a half and I haven’t developed this symptom. That said, though, I’m not sure what the risk factor is for Abilify in relation to Risperidone.

So there are, in fact, quite a few reasons why I shouldn’t go on Abilify. It seems, just from the readings I’ve done, to be more risky and potentially side effect-y than Risperidone. But it might be a valuable tool as an adjunct treatment – a lot of people are reporting great successes with it. I really wouldn’t want to miss out if there was a chance that this medication could help me.

The last thing I discussed with my psychiatrist was my anxiety. Due to certain environmental factors in my life at the moment and in the past few weeks, I’ve been a lot more anxious (in certain situations) than usual, but I also feel like my base level of anxiety has risen. I’m anxious about some things that are typical of people with anxiety disorders – social situations, public places, taking transit, the police/authority figures, etc., but I’m also anxious about other things, like getting out of bed. This anxiety is seriously keeping me from getting things done because it totally shuts me down and renders me unable to make effective decisions. Given all that, I decided it was time to ask my doctor about trying anxiolytic medication again. He’s really not a fan of benzodiazepines in the first place, and especially not in my situation, so he ignored them altogether and considered some other options. He ended up deciding that if the Cymbalta doesn’t have any anti-anxiety effect on me in 5 weeks, he’ll start me on a trial of Buspar (Buspirone). I’ve been on Buspar once before but the results were inconclusive. I don’t think we gave it enough time or a high enough dose to really see what it could do for me.

Anyway, here’s an idea of what my current meds look like. There’s some new additions in both the prescription and non-prescription categories.

Cymbalta (Duloxetine): 30mg nightly – for Depression
Imovane/Immovane (Rhovane) (Zopiclone): 22.5mg nightly – for Insomnia
Risperidal (Risperidone): 2.5mg nightly – for Tourrette Syndrome
L-Tryptophan: 1000mg nightly – for Insomnia
Dexedrine (Dextroamphetamine) Spansules: 40mg in the morning as needed – for Depression-related symptoms
Chloral Hydrate: 10mL nightly – for Insomnia

Clindoxyl (Clindamycin and Benzoyl Peroxide): apply topically at night – for acne
Delatestryl (Testosterone Enanthate): 60mg intramuscular once weekly (Friday) – for low testosterone
Erythromycin: 333mg in the morning and at dinnertime – for acne
Losec (Omeprazole): 20mg in the morning (before eating) – for acid reflux
Fucidin (Fusidic Acid): apply topically once daily – for Impetigo

Melatonin: 3mg nightly – for Insomnia
Multivitamin: 1 in the morning – for overall health
Salmon Oil: 1 in the morning, at dinnertime and at night – for high cholesterol
Vitamin C:  500mg in the morning – for overall health
Calcium + Vitamin D: 500mg Calcium and 125IU Vitamin D (1 tablet) in the morning and at night – for bone health
Valerian Root: 800mg (2 tablets) nightly – for Insomnia and Generalized Anxiety Disorder
“Stress Relief” B50 Complex with Sensoril: 1 capsule nightly – for anxiety
Siberian Ginseng: 250mg (1 tablet) in the morning, at dinnertime and at night – for stress and low energy
“Relaxing Night” herbal tea*: 1 bag steeped in hot water nightly – for Insomnia

* “Relaxing Night” tea contains Chinese jujube, subterranean fungus, white mulberry, lycium barbarum, and Chinese yam.