Cymbalta

Good question! I can answer this from a personal standpoint. My NP prescribed Cymbalta for me last year and it was amazing. It literally kicked in within 2 days and had a noticeable effect on my depression. The side effects that were most distressing were decreased sex drive (huge decrease) and 15 lb weight gain within several months. Still, the drug was worth it. My life turned around completely within days. Unfortunately, I changed jobs and with it came a change in health insurance that did not want to pay for Cymbalta. I was switched to Effexor XR which has not had any weight gain, but the sex drive has not returned either. The worst part of this drug is I've noticed an increase in anxiety and panic attacks. I'm giving it a few more months just to see if this continues, but eventually I'm hoping to get back on the Cymbalta.

Hope this helps some. :)

Another firsthand report: initial dose of Cymbalta produced such nausea that I wondered what the he** I had done to my doctor to make him hate me so much to put me through this. But it got better.

Otherwise, it is a lot like the Effexor, especially side effects. My main side effect with Effexor was wild dreams when my dose was too low. Cymbalta gives me interesting dreams all the time that become nightmares when dose gets low. So bad that I have gotten out of bed to take my meds. (okay, so I am not the most timely of medication takers. And I do have a history of nightmares). Other than that I love Cymbalta as much if not more that any other I have tried.

Thanks for the first-hand reports! It definitely does help....sounds like at least a looong discussion about potential side effects is in order!

Jan

Another firsthand report: initial dose of Cymbalta produced such nausea that I wondered what the he** I had done to my doctor to make him hate me so much to put me through this. But it got better.

Otherwise, it is a lot like the Effexor, especially side effects. My main side effect with Effexor was wild dreams when my dose was too low. Cymbalta gives me interesting dreams all the time that become nightmares when dose gets low. So bad that I have gotten out of bed to take my meds. (okay, so I am not the most timely of medication takers. And I do have a history of nightmares). Other than that I love Cymbalta as much if not more that any other I have tried.

Well that explains the anxiety dreams I've been having. I think a call to my NP is in order. Thanks for the heads up.

I work with pain management patients. I prescribe a lot of Cymbalta due to the SNRI effects. A lot of my patients have the depression, sleeplessness, as well as pain. It also works well with neuropathic type pain (numbness, tingling, burning, sharp, shooting pain) that keeps a lot of my patients from sleeping through the night and functioning during the day. I find that if Neurontin, Gabitril, and the new one Lyrica is not helping for the neuropathic type pain then I will switch them to Cymbalta as well. Some side effects that I've had reported are irritability, nausea, and weight gain. The majority of patients are on 60 mg QD but I've got some on 60 mg BID. A lot of my patients also want a "quick fix" so I have to remind them to give it at least a month or longer to take full effect, shorter if I'm switching them from Effexor XR or some other SSRI. I'm attending a dinner/lecture this Tuesday on Cymbalta and how it helps with depression and pain so I'll try to post back some things I learn from the speaker (he's some well-renowned psychiatrist, I can't remember his name).

Frankly, unless a pt. has a pain problem I've not found Cymbalta superior to EFFEXOR XR AND IT'S ALOT MORE $$$$$.

Thanks everyone for sharing your experiences. I have also checked the local pharmacies and definitely found Cymbalta to be more expensive than Effexor XR (expected, since they won't NEARLY have covered their R&D yet). ACNP, thanks for the relevant info on pain management. I was curious as to how well it actually worked for pain. My patients' pain is typically GYN-related, as opposed to neuropathy, so I get very little experience with treating neuropathy (maybe the occasional diabetic pt. with neuropathy). So it's good to know that it is actually effective for pain if I need to use it for that indication as well. Thanks also for any feedback you can give me from your upcoming dinner lecture! (Maybe you can also report back what you had for dessert...I'll have dessert vicariously! )

Jan

How about the pain of fibromyalgia? I've had a few patients tell me it worked like a miracle drug in 2-3 weeks. but the weight gain is really concerning

Okay, here goes. From the dinner/lecture I attended the most common side effects from Cymbalta were nausea, constipation, and dry mouth (anti-cholinergic effects) in the studies. The nausea should subside within the first week. The speaker also kept saying that Cymbalta is weight neutral meaning it's not supposed to make you gain weight. One thing that the speaker did leave out that the Lilly people do not tell you also is that if your patient smokes, they are receiving 1/3 less of the drug due to some interaction (I learned this today from our Effexor rep). One thing I don't like about Cymbalta is that it took over 10 years before it got approved for public use and it only used about 12,000 people in its study. Also, it has only been compared to Lexapro which is just a SSRI. I would like to see a side-by-side study between Effexor XR and Cymbalta. However, the only drawback with Effexor is making sure they don't develop high blood pressure and it is only 40% plasma protein bound making it "supposedly" have more side effects or drug interactions. Plus, your patient can't skip or miss a dose due to the withdrawal effects. I think I have a fair amount of patients on equal Cymbalta and Effexor. The doc that I work with doesn't even prescribe any SNRIs or SSRIs. He still prescribes a ton of Elavil and Pamelor (old TCAs)!! I don't like these b/c they have so many side effects. Oh well, guess I could do my own study :) and see which one is better tolerated with good results.

P. S. The dinner was Ruth Chris Steakhouse (excellent) and I had the cheesecake for dessert. It was worth every calorie and fat gram!!!

Thanks ACNP for the update on your dinner lecture! (And dinner sounds yummy too! :chuckle ) Zias also mentioned fibromyalgia. I have a patient with fibromyalgia that I just put on Cymbalta yesterday! So I'll let you know how that goes. I thought if it works well for neuropathy, it's worth a try for fibromyalgia. And she definitely has the depression indication.

Hi:

I am a PMHNP in Kansas-- have been treated for MDD for many years, and had been well managed with Lexapro. I also have RA and Fibromyalgia, and my doc wanted to switch me to Cymbalta. They did that, and I did well without NSAID's and the depressive sx. were well managed. About 2 mos after initiating treatment with Cymbalta, I began experiencing severe insomnia. Even though I take Ambien nightly for this, I began staying awake all night, or until 3 or 4am. The serotonin and norepinephrine reuptake inhibition activities created severe insomnia for me. Just a word to the wise.

Morghan, MSN, ARNP

Kansas

Although it is not a SNRI, I take Wellbutrin. No sexual side effects, no weight gain. I haven't had success with pure SSRIs so I figured I would try something that acted on dopamine and norepinephrine. Like effexor, it does increase anxiety. I am tempted to come off for that reason.