Latest anti-depressant to hit the market
This one's an SSNRI!

http://pi.lilly.com/us/cymbalta-pi.pdf

I haven't even got past the first page, and already this seems like quite the wonder drug! After I read the whole thing, I might ask my psychiatrist about it. :) Thanks for the linky!

Interesting... I don't think I'll be looking at this drug for myself after all. The prescribing information indicates approximately a 1% potential for hepatotixicty, along with possible increases in hepatic tumors (demonstrated by rodent studies). In other words, it sounds like this drug has the potential to mess up your liver.

I imagine a doc prescribing it might require periodic liver enzyme checks. Personally, I prefer to be poked and prodded as little as possible.

I was initially thinking about trying this along with the Wellbutrin I've been taking, but the literature indicates that both are highly protein bound in blood plasma. Taking the two together would mean that there would be increased plasma levels of both drugs and that they could exacerbate each other's side effects.

So, it looks like a no go for me. :)

I think you are seeing potential problems in the PI sheet that aren't really a significant risk. All drugs are hepatoxic to some extent - drugs are metabolized by the liver, and in sufficient quantities, most drugs can cause problems. For example, Have you ever taken Tylenol? Acetominaphen is very hepatoxic, but this is only a problem if you take a lot of the drug - as in overdose - or you take large doses for a long period of time.
The PI sheet says specifically "Three Cymbalta patients had elevations of transaminases and bilirubin, but also had elevation of alkaline phosphatase, suggesting an obstructive process; in these patients, there was evidence of heavy alcohol use and this may have contributed to the abnormalities seen. Two placebo-treated patients also had transaminase elevations with elevated bilirubin. Because it is possible that duloxetine and alcohol may interact to cause liver injury, Cymbalta should ordinarily not be prescribed to patients with substantial alcohol use."
So unless you are a boozer, or have a cirrhotic liver for some other reason, there should generally be no problem. My thoughts are that the patients taking an antidepressant like Cymbalta during a drug study are going to be more likely to abuse alcohol than average, due to the fact that they are depressed in the first place. The doctors running the study would screen for alcohol and drug use, but people are known to lie about such things, especially if they are being paid to be part of a drug study and want the small amount of extra cash and the free drugs provided as part of the study.
Doctors running drug studies will report all problems that are encountered, even if they are not related to the drug being studied, so you sometimes see strange adverse reactions on the PI sheets, so you need to compare the side effects from the drug to the side effects from the placebo to see if the side effect is really from the drug.
Here's an example - I am taking part in a study for a new gout medication (it lowers the uric acid levels in the blood), and during this study, I was diagnosed with ADHD, and that diagnosis was noted by the study doctor as an "adverse event". If by chance there is another person, or two, such as myself, you might see ADHD listed as a side effect of the drug, since I didn't officially have the condition until after I started taking the study drug! Of course I've had ADHD my entire life, it just wasn't diagnosed til recently.
With regards to interactions with Wellbutrin, Cymbalta is metabloized by two enzymes and one of them is surpressed by bupropion, so taking Cymbalta with Wellbutrin would result in the Cymbalta lasting longer in your body than it would without the Wellbutrin. Your doctor would likely use a smaller dose of Cymbalta if he were to add it to the Wellbutrin. Wellbutrin levels should not be affected by the Cymbalta as the enzymes that metabolize it are not used in the breakdown of Wellbutrin.

it does not seem to have the problems with the sex stuff like the ssri's
has anyone tried it yet?

have ot ask my doc about it
as i am taking 300 mg of wellbutrin and may need more as it is not quite enough.

i found a way to get rid of the adderal tireds
i take 50mg of provigil wait i hour take about 7mg of xr adderal, (i weigh out 80 mg of the little beads from the capsule, there are 130mg total in a 10mg capsule, my doctor is cool with this, 10mg is too much 5mg not enough) then later in the day i take another 50mg of provigil and maybe 2.5-5mg of the imediate release adderal.
i also take 300mg of xl wellbutrin.

but i think i need more antidepressant.
cause if i take one of my 150mg wellbutins i have left from a few months ago it helps.

have to talk to the doc about this.

anyway anyone who tries this let us know about it.

will ask my doc and relay what he says.
he is one of those young hotshots from the upper east side here in nyc, teaches and treats kids with everything from add, aspergers, autism and psychosis.
it's nice to know i am one of the healthier patients, only add, depression, and pdd!!!!

There's a guy on another forum who says after trying everything else for a number of years for his ADD, that Duloxetine (Cymbalta) was working better than anything he has tried.

It should be a potent treatment for ADD, due to its ability to block dopamine uptake in the prefrontal cortex. Basically, if you block uptake of NE in the Cortex, you also block Dopamine.

Another potent duel inhibitor, which should be approved in 2005, is Milnacipran. Milnacipran has a very mild side-effect profile and is not metabolized by cytochrome 450. You can get Milnacipran overseas.

I wasn't having much success with Adderal XR and Wellbutrin, so my pdoc substituted Cymbalta for the WB (there was a stretch of several weeks between ending WB and starting Cymbalta). The first week (30mg) I slept more deeply but developed a feeling I'd call benign unconcern. I'd wake up fine, but get out of bed? Oh yeah, I guess I'll do that in a minute or so. Get ready for work? I guess I have to do that soon...oh, look at the time. Gee, I guess I ought to be moving along.... There was a marked lack of urgency and I felt I was backsliding in terms of motivation and focus. - not good for ADD.

But, being game, I upped to 60mg the 2nd week as planned - and not only did the unconcern and lack of urgency deepen, I had a bad reaction that I think was due to the Cymbalta. I hadn't eaten since breakfast (not atypical for me), and in the early afternoon I suddenly developed a growing wave of intense nausea and weakness - I thought I might pass out, and really needed to sit down or lie down. I broke out in a deep sweat all over, my whole body felt shaky, and my hands in particular were tingling so much they literally were vibrating. The episode lasted about 30 minutes before starting to subside, and it took a couple of hours before I felt safely OK.

It turns out that the maximal concentration of Cymbalta occurs 6 hours past dose (the timing was about right), and that food delays the time to reach peak concentration and also lowers absorption a bit. So, was it a coincidence? I don't know, but I've never felt that way before and don't want to again, so for that reason and the "unconcern" I stopped immediately.

I'd be curious to hear about other people's experiences.

Cymbalta is a fairly toxic drug. I wouldn't recommend it.

You're apathy and amotivation was probably just as much of an effect of rebounding from the high Dopamine and Norepinephrine in the Wellbutrin, as it was from increased Serotonin in the Cymbalta. It's likely the Norepinephrine from the Cymbalta would have increase your motivation and concentration had you continued to take it. It takes about 1.5 months for NE uptake inhibitors to start working.

Milnacipran is a duel inhibitor that favors NE over Serotonin. It's reasonably non-toxic and has a relatively benign side-effect profile. It's scheduled to be approved in late 2005. But, because of the corupt control by Lily and other drug companies, the FDA will probably reject its approval like it rejected Reboxetine (a relatively non-toxic low side-effect European version of Lily's latest poison, Strattera).

I am on my second week now of Cymbalta. I switched over from Lexapro. I was on lexapro and adderall and this combo brought out OC tendencies and overfocus problems. I also ahd side effects from the Lexapro. I stayed on the adderall and then started cymbalta. I had no side effects other than I was sleepy for the first couple days. I got over that after 3 days- even though I was fighting a cold and allergies. I have found this combination to do very well for me. My concentration is very good. I have noticed an increase in reading comprehension and my moods are level with the exception of the first 3 days of the transition. My energy is good but not thru the roof. I can eat and sleep normally. I am very pleased. Another interesting thing is I can not tell anymore when the adderall wears off. I could when on Lexapro and adderall. I am not sure why this is but its a nice effect. I will probably start decreasing the adderall and see if I can do without it.

Cymbalta has an effect on noradrenaline - as does Adderall, but of course, in a different way - and this is likely why you no longer notice when the Adderall wears off - that or you are getting used to the Adderall???
It's great when a medication seems to treat ones symptoms so well!

i posted this in the adderall section as well, but basically i take adderall IR, wellbutrin and klonopin. my diagnosis is panic disorder with out aggrophobia and AD/HD inattentive type. anywho, i found out today that i am allergic to the WB. caused unbarable hives, so i cant take it anymore. that and they are scared that it might, the reaction, get worse. :( i am so sad b/c this med worked for my anxiety and anger issues. oh well, thats the way life goes i suppose. anyway, so how do any of you, if you take the adderall/cymbalta combo fair with it. is it similar to WB, i.e. if you took that before. i just had so much success with the WB and adderall, i felt good for the first time in 26 years. also i have lost some weight, like 20 lbs since i started the med a month ago, needed to loose it, but i feel so good now. im happy :D. from what i read, cymbalta doesnt cause much weight gain. i just liked the side effect of weight loss in both meds, though at first it scared me how fast i was loosing it. i also noticed that with both meds i didnt crave sweets. anyway, you can tell that my adderall has worn off. so any input, reply or PM me. thanks
-heather

I was able to switch right over to 60 mg Cymbalta from 40 mg Strattera and 40 mg Lexapro with no interruption in meds. I have been on ADD meds for a year and a half, but was starting to suffer some really bad depression. We added Lexapro to my Strattera and 25 mg Adderal XR, and it helped a lot. When I learned about Cymbalta having the same effect as both the Strattera and Lexapro combined, I jumped at the chance to take one less pill each day. Cymbalta has been working even better than the old combo, and I'm back to my old productive self again. I did start having a lot of trouble with daytime drowsiness about 4 hours after the Adderal, so the doc upped the dose to 40 mg. My sleep has been terrible the past few years and the Cymbalta has helped a little, but I wish I could stay asleep longer than 5 hours. For me the same sexual side effects I got with the Lexapro continued with the Cymbalta.
Keith :p

I've been taking Cymbalta now for almost 6 months (for anxiety/depression), and had a liver panel done in August because it was recommended for people on this medication. My Alkaline Phosphatase is high, and after a barage of tests, there has been no liver imparement found, meaning it is probably the result of the Cymbalta.

I am only on half the dosage (30 mg) because the full dosage makes me sleep for 12 hours a day. I found that the medicine makes me lethargic, sick to my stomach, apathetic, and decreases my sex drive and ability to climax. I've tried to come off the medicine, and I got really bad "brain shivers". I'm going to try to transition to another medication over Christmas vacation.

These are just my experiences. I wouldnt' recommend taking this drug unless you really need it.

I have just started taking it. Well, actually, I took it for a month and stopped and restarted a few weeks later. Stupid I know, but I am very resistant to the idea of having to take anything. In the end I started to get so depressed again that I thought I better give it a clear shot.

For the first week it makes me foggy and nauseous. Am still at that stage now, but last time I distinctly remember suddenly feeling a lot better.

its also meant to help with FM pain.

I just started taking Cymbalta yesterday.

I am experiencing some uncomfortable side effects, but nothing too severe that so far I can't handle (although it has increased my anxiety a bit which I don't like.:( I think this will pass, though).

There are some aspects of it that are reminding me of the Strattera - that would be fantastic!!!!!!

Unfortunately I could not continue with the Cymbalta trial.

I could not handle the lowest dose (20mg), so I divided the pellets in one capsule to create a lower dose. However, this did not help - the Cymbalta continued to aggravate my depression. I became more and more depressed on the stuff as the days went on. It was horrible! I am really disappointed because I had high hopes for this med, and was noticing it was doing something for my ADD.

Does anyone know why Cymbalta could make my depression worse?

Cymbalta did not work for me with the fibro symtpoms I was having. In fact I probably felt worse, not as bad as I was on paxil but pretty bad.

Just my experience.

The Pshchiatrist my PCP refered me to wanted to start me off on a "clean slate" eliminating: Lexapro20mg, Xanax .5mg & Adderall XR 20mg, after 3yrs of being on them. (Co-morbid ADHD +PTSD/PD/CD/RAD)

He placed me on 30mg Cymbalta, 'minipress' & Vyvanse 30mg. I lasted 3 days on cymbalta. Approx. 10min after my 1st Cymb. dose, my face went totally numb, pins/needles sensations in legs& slept 24hr straight. (Normally a 4hr sleep person.) Not ever wanting to feel like that again, I STOPPED the cymbalta, returned to Lexapro (increased to 30m/day & stayed w/the 30mg Vyvanse.

I have a real sensitivity to antidepressants; but Lexapro worked the best for me: minimal weight gain/lethargy, no increase w/sleep or appetite. I learned that Cymbalta was used for years as a painkiller for diabetic nerve pain (which may explain my full-bodied numbness I had after taking cymbalta that time).

Based upon my experience, I wouldnt recomend cymbalta to anyone.. thanx!

I had the same experience with Cymbalta making my depression MUCH worse!! Even opening the capsule and measuring it out grain by grain didn't seem to help. And it had that effect within twenty-four hours-- wow, was it ever bad. The same thing happened the last time I tried it, but this time I really thought it would work if I lowered the dose so much. The last couple of days are maybe the worst I've ever felt, and THAT statement has a lot of competition. :P

cymbalta made me so amazingly sick it was absolute torture i hated it...

Very worst medication I ever took - even worse than serzone. This stuff is toxic in my estimation and I throw stuff occasionally at my teevee since there are so many freaking ads for it.