Tuesday, August 12, 2008

Cymbalta Update

Here's the way my new depression medication was explained to me:

Imagine your depressed brain is the side of barn. On that barn there are three targets. These three targets are the neurotransmitter receptors for seratonin, norepinephrine, and dopamine. Antidepressants are like arrows being shot at the targets. Taking Lexapro, an SSRI, was like firing an arrow at the same spot on the seratonin target over and over. It works for awhile, but eventually you've shot arrows at the one spot for so long there's nothing left to hit. That part of the target is just a hole. If you switch to a different SSRI it aims at another part of the seratonin target and can help alleviate depression symptoms. That still leaves the other two targets untouched. What you do with those target depends on your symptoms. For me, my depression involves a lot of anxiety and intrusive thoughts so I needed the SSRI to take the edge off the anxiety but I needed something more for the intrusive thoughts. The psychiatrist I met with recommended Cymbalta because it is a SNRI (seratonin-norepinephrine reuptakte inhibitor). It works on two targets at once.

I started taking the Cymbalta on the 15th of July and the intrusive thoughts stopped after about a week. After about two weeks I noticed that I was hvaing more fun with my kids. I didn't mind playing on the floor with them or horsing around as much. I seemed to have more patience. Also at around two weeks I began feeling motivated to do housework (much to my husband's delight!). I'd never given up completely on the housework but I always found it overwhelming and it took a lot energy to work up to doing it. I could never figure out where to start and I spent a lot of time feeling distracted and forgetting what I was working on. After the Cymbalta had begun to kick in I was able to focus better and keep the house cleaner. (Notice I didn't say it was clean, just cleaner. If I could only get my kids to put their toys away!) I also started sleeping a lot deeper and would actually wake up refreshed on occasion. I've had a few crazy dreams. My favorite one was when I dreamed that my husband had to take all my friends as plural wives. It quickly turned into some sort of bizarre, pioneer-era Bachelorette show with me constantly protesting, "I get to be the first wife because I already had his children!" Like I said, CRAZY dreams. Anyway, Over the last week I've noticed an uptick in my energy level. I've even started working on my book again.

So that's all the good. Now here's the bad. The list of side effects for Cymbalta includes: nausea, increased sleepiness, and increased sweating. I have all those. So much so that I took a pregnancy test just to make sure I didn't have an accidental bun in the oven. (I don't. Thank goodness! I'm just not ready for more kids yet . . .) The nausea has been manageable but it still surprises me. The sleepiness has been almost comical. For the first week or so I HAD to nap every afternoon. One day I sat down to rewind a movie for the kids and just konked out. When I woke up two hours later my 2 1/2 year old was buck naked and snuggled up next to me eating candy while watching the credits roll. My five year old was just relaxing on the couch and my one year old was still napping, but I could tell I'd missed something. I'm still pretty sleepy but if I keep working I can get through it. It's odd to me that I'm sleepy but I have the motivation (and sometimes the energy) to do so much more housework and stuff. The sweatiness is, um, really kind of gross. I have to keep a towel nearby when I work out and I'm betting our electric bill will go up since I've been using the air conditioner a lot more. Oh, and I'm thirsty all the time.

When all is said and done I'm glad that I started the new medicine. It's been good to feel more functional and I just feel more relaxed since I'm not constantly combatting images of knives and blood (those are the intrusive thoughts). But the side effects are enough to make me want to wean off this as soon as possible. Which I think means at least six months. Maybe a year. The psychiatrist I meant with says maybe never. For now, I'm just taking it one day at a time.


Elizabeth-W said...

Can you fiddle with the time you take the Cymbalta a bit? Are you dosing once or twice a day? You know I'm not a dr, but.... :D
If you're taking it at bedtime, maybe try moving it up (earlier) an hour or two?
If it is once daily, maybe you could break it into two doses?
The good news is that it seems to be doing what it's supposed to do! I think the sleepiness is a side effect you can maybe fix or at least moderate. And if you're taking it in a once daily dose, maybe doing it twice daily could help tone down the nausea?
Just some thoughts. Best of luck!

Breakdown said...

I just discovered your blog and I find it very inspiring.

I hope the best for you as you battle this very debilitating disease.

Charlotte said...

Sounds like you are doing pretty well with it. Usually the side effects lessen or go away with time so hopefully that will be the case with you! Hang in there, girl! Glad to hear you sounding like yourself again:)

Laura said...

elizabeth-w--thanks for the advice! It didn't occur to me to change the time I take it. I've switched to breakfast now and that seems to help.

Breakdown--Welcome! Thanks for saying I'm inspiring. It made me smile. Be sure to come back and share what you've learned. We all benefit from each other's wisdom.

Charlotte-thanks for being my sister and thanks for caring for me.

Elizabeth-W said...

Oh I'm so glad--both that it is helping, and that you hadn't thought of it. After I posted it, I almost took it down for fear it came off as totally patronizing and too simplistic. But, I have conversations with people pretty regularly who hadn't though of it, either, so I thought it would be good to throw it out there.

RoeH said...

I've been taking Cymbalta for about 2 years or more. Like everybody, I'd love to just quit it completely. I hate having to take pills and I don't know whether this really helps or not. So much of my life is situational. Doctors will not talk about stopping anti-depressants once you get started so now I really don't know what I would be like off of it. I have gained about a million pounds while I've been on it and doctors will not believe that either. And that is the worst part....the weight. I'm tempted to just quit for that reason alone. Elizabeth's comment is interesting. I have never before thought to take it at night instead of morning. I might try that. The whole thing is maddening to me. It's still a stigma so I don't tell many people I'm on them. No one really understands what it's like. If you don't mind, I'd like to keep up with your blog. Thanks.

Anonymous said...

My name is Lucas Sneed and i would like to show you my personal experience with Lexapro.

I am 39 years old. Have been on Lexapro for 3 years now. Went through a phase in life where I lost my job and was under-employed for a couple of years. Had descended to an all time low in self-loathing. Doc intially placed me on Welbutrine, which made me un-motived and essentially a disinterested by-stander in the story that is my life. Switched me over to 10mg dose of Lexapro, which has never increased. I now have a job I love (OK, like) and do not worry about the future. I continue to take Lexapro, as I said I am not as easy going if I miss several doses. My wife can tell when I am off of it, as little things will drive me nuts: barking dogs, annoying habits of others, other drivers, belligerent children...the usual list of suspects. My mother's side of the family is full of passionate, emotional rage machines, so it is a genetic thing or I am a product of the environment in which I spent my formative years. When I am on it I am calm cool and in control. Have notfound it to be physically addictive nor experienced any side effects.

I have experienced some of these side effects-
Uneven temperment, lack of patience if I skip several doses.

I hope this information will be useful to others,
Lucas Sneed

Laura said...

Lucas--welcome to my blog! Thank you so much for sharing your experience. If you are interested I would love to have share more of your story and how depression has effected your life. If you are interested pleas email me at lolapalooza AT hotmail DOT com. Put your name or "depression profile" in the subject line. I look forward to hearing from you!

Anonymous said...

Thanks for sharing! I've been on Cymbalta for about 5 months now, and can relate to your symptoms! I have WILD dreams when I forget a dose and wake-up sweating like I've just ran a marathon. Otherwise, things are a lot better. I was on Zoloft for a few years and it eventually didn't 'do the trick' anymore. I'll never go back!

Anonymous said...

It's good to read another LDS perspective from someone who deals with intrusive thoughts. I've found a few ways to help with mine. I don't have any prescriptions, but they're certainly severe enough for that.

Anyway, I've found that smiling gets rid of them. Really. They just disappear. It has to be a real smile, though. I have mania-type issues, though, that smiling too much makes worse, so I can't do that all the time.

Listening to church publications while I sleep helps a lot, whether music, magazines, conference or manuals. It also helps get rid of racing thoughts so I can sleep. Yes, it's way easier to sleep, usually, this way, and I feel a lot better all throughout the next day, but speakers at low volume are much easier to handle than headphones. This really, really, really helped with my dreams, too.

Avoiding positions where my spine is twisted helps a ton. For some reason leaning my head against my hand with my arm propped up with my elbow against my pillow while lying down and all such as that make them a lot worse. So do pillows being too high/low/thick/thin such that my head isn't at the right angle.

Going to the bathroom as soon as I feel the urge helps a lot. They get worse if I don't.

Breathing more helps to get rid of them. I find that I'm not breathing much when they're the worst usually.

I believe playing games helps.

I have a suspicion than oil pulling helps, but I could be wrong.

Not watching anything but G or approved PG movies helps me a lot. I prefer preschooler cartoons, but people I'm around can't seem handle that very easily. Watching church videos helps.

Exercise helps. I suspect this is in part because it contributes to spine/bone health and for some unknown reason that has to do with my intrusive thoughts. Minerals also can affect them, for better or worse.

Different colors of light can affect my thoughts as can different colors of noise (i.e. white/pink/brown/blue noise). I prefer LED lights without blue, usually. There's some science behind that. Lack of blue and perhaps green light triggers melatonin production. I'm sure there are other chemicals involved and different colors probably do various things. I think how appealing the light is plays a part. Psychology pays a role.

B vitamins sometimes help (especially B12).

Filtering my water actually helped a lot. A Brita filter works well. Don't drink distilled water, though. I did that for years and it was giving me bone and tooth issues that went away when I quit. It took me a while to figure out the connection.

Malic acid makes them way worse for me for many days. I need to avoid that stuff like the plague, except in naturally occurring amounts. I took it to detox aluminum.

Most of these suggestions help me a lot with depression, too. What I eat helps me more than most things there, though. Hydrogenated oils make me depressed.

Anonymous said...

As for depression, I forgot to mention that eating some large stalks of broccoli completely cured me of depression for about a day every time I did it.

Unknown said...

I am 60 years old and had a bout of bad depression when I was 30. I thought I would never have it again. I didn't know it can re ac cure, so I was put on celexa, and tried 4 times and could not handle the side affects. Now I am 1 day into Cymbalta,I had alot of nausea last night. I have a new marriage and 3 grown amazing Son's I only hope this works for me. Feeling frustrated.