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What Can You Add To Cymbalta To Help Combat Anxiety Disorder?


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#1 piemachine

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Posted 28 February 2013 - 01:16 PM

I am currently on Cymbalta, but I still have severe anxiety problems. I know I can't stop taking the cymbalta because it does help me, but I need something else with it to give me a boost. What other SNRI or SSRI could I take with Cymbalta for anxiety disorder? I don't want to get Serotonin Syndrome.

 

Thanks for everyone's help.


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#2 Sunset Soon Forgotten

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Posted 28 February 2013 - 01:49 PM

I'd have to suggest you look beyond SSRIs and SNRIs. From your other posts you seem to be a bit hung up on combining meds that aren't terribly safe in combination.

 

There are also all the benzodiazpines, Propranolol, gabapentin and others that might help. Or you might have a look at trying tricyclics instead of SSRIs (not with SSRIs). Many or most  tricyclics are as effective as SSRIs, they just aren't used as much anymore because you can OD on them, but they tend to be sedating and be more likely to help with anxiety. If you aren't suicidal, they're worth a look.

 

For me benzos are the only thing that work for anxiety or panic. Other people are different. If your anxiety symptoms are mostly physical (pounding heart, sweating, feeling like you're going to pass out, etc) than Propranolol is definitely worth a try.


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Many of my posts are edited or have typos because I often post from my phone. I do my best to edit before any responses have been made.
 

Current meds, which sort of work: Remeron (mirtazapine) 30mg hs, Lamictal 100mg bid, Xanax 0.5mg qid, Zanaflex (tizanadine) 2mg bid, and heart meds
 
Crazy Meds that didn't work, or made me worse, or had side effects from hell, or were discontinued because my pdoc was playing med roulette: (definitely incomplete, in alphabetical order, mostly but not exclusively by trade names): Agomelatine, Ambien, Amitriptyline, Ativan, BuSpar, Celexa, Clozapine, Cogentin (for oromandibular dystonia due to APs and AAPs), Depakote, Deseryl, Effexor, Imipramine, Klonopin, Lexapro, Lithium, Mellaril, Paxil, Perphenzine, Prozac, Risperdal, Tegratol, Triavil (at a different time than just amitriptyline or just perphenazine), Valium, Wellbutrin, Zoloft, Zopiclone, Zyprexa 

 
I'm a new day rising

I'm a brand-new sky to hang the stars upon tonight

But I'm a little divided

Should I stay or run away, and leave it all behind?
- foo fighters
 
 


#3 Anyone

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Posted 28 February 2013 - 02:56 PM

One of your listed meds is Abilify.  At least in my case, Abilify made my anxiety worse when I tried it.  Since it's activating, I'm probably not the only one for whom it does that.  Are you sure it's helping you more than it's hurting you?

 

While I agree with SSF that benzodiazepines are the most effective treatment for anxiety in most cases, it depends on your Pdoc's view of them whether he'll prescribe any for daily use.  The chance of bad withdrawal symptoms, if you ever withdraw, is definitely real but I consider it overrated, as rapid withdrawal from SNRIs like Cymbalta or from AAPs can also be awful.  I also agree that even outside of benzos, the other mentioned medications are good anti-anxiety drugs in some people.

 

I do disagree with SSF about the apparent belief that one should take only one antidepressant at a time.  I take both Cymbalta and Nefazadone, and I'm convinced that both help me, and I think Nefazadone is a particularly good AD for treating anxiety, sort of an SSRI/SNRI but one that blocks a couple of serotonin receptors that tend to increase anxiety (whereas in general more serotonin is very good for decreasing anxiety).  A lot of docs won't prescribe Nefazadone, because it causes liver problems in what's really a quite low number of patients.  It's probably not as effective as a benzo would be, but I'd see adding it as an option.

 

I have no idea whether it's safe to take a tricyclic together with an SNRI, but would say (without ever having taken a tricyclic) that from what I know of them they can be very effective drugs, as SSF said.


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#4 Each Coming Night

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Posted 01 March 2013 - 01:32 AM

Seriously OP? You keep asking about combining Cymbalta with other SSRI/SNRIs


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#5 Each Coming Night

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Posted 01 March 2013 - 01:45 AM

@anyone - Sunset is most definitely not against the idea of taking more than one AD at a time, and a quick look at her current meds confirms that. What she and I have been trying to get this poster to understand is that mixing two SSRIs/SNRIs is potentially extremely dangerous without direct pdoc supervision, especially since he's already on the max dose of 120mg Cymbalta.
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#6 Sunset Soon Forgotten

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Posted 01 March 2013 - 08:27 AM

@Anyone - as of Monday I will be on three meds with antidepressant activity (I'm about to start agomelatine). None of them are SSRIs or SNRIs. I don't have any problem with combining antidepressants in general. OP, however, knows that combining SSRIs can be dangerous and seems bent on doing it anyway.


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Many of my posts are edited or have typos because I often post from my phone. I do my best to edit before any responses have been made.
 

Current meds, which sort of work: Remeron (mirtazapine) 30mg hs, Lamictal 100mg bid, Xanax 0.5mg qid, Zanaflex (tizanadine) 2mg bid, and heart meds
 
Crazy Meds that didn't work, or made me worse, or had side effects from hell, or were discontinued because my pdoc was playing med roulette: (definitely incomplete, in alphabetical order, mostly but not exclusively by trade names): Agomelatine, Ambien, Amitriptyline, Ativan, BuSpar, Celexa, Clozapine, Cogentin (for oromandibular dystonia due to APs and AAPs), Depakote, Deseryl, Effexor, Imipramine, Klonopin, Lexapro, Lithium, Mellaril, Paxil, Perphenzine, Prozac, Risperdal, Tegratol, Triavil (at a different time than just amitriptyline or just perphenazine), Valium, Wellbutrin, Zoloft, Zopiclone, Zyprexa 

 
I'm a new day rising

I'm a brand-new sky to hang the stars upon tonight

But I'm a little divided

Should I stay or run away, and leave it all behind?
- foo fighters
 
 


#7 piemachine

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Posted 01 March 2013 - 11:56 AM

Thanks for your replies. Humm, maybe I should look at tricyclics, but I have a problem with a buzzing in my ears that started when i tried switching snris and taking several ssris. I went back to cymbalta and still after a year i still have the buzzing in my ears, so I am really cautious about stopping the cymbalta.

 

Can i still take the cymbalta and try adding a tricyclic?

 

Thanks again,

Peter


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#8 Blue Heron

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Posted 01 March 2013 - 12:44 PM

Please stop asking variations of the same question in different topics, piemachine.

 

You asked about Wellbutrin in a different post. That's probably not your best bet, since it's activating. Ask your doctor which med he'd recommend. Therapy can also be good for reducing anxiety.


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#9 Bluechick

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Posted 01 March 2013 - 04:42 PM

Yeah, if you're looking to reduce anxiety, I don't know if Wellbutrin is the best idea.  It is definitely activating for me and it increased my susceptibility to anxiety.  The only reason I stay on it is that 1)  it helps me immensely and 2)  I have great coping skills when it comes to anxiety.  If I didn't have the skills I have to cope with anxiety then I really don't think I would be on it.


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#10 notfred

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Posted 01 March 2013 - 07:42 PM

Geez, all this fuss. Just take a benzo.


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I am in full remission (296.36) from Depression. Insomnia, ADHD-PI, Epilepsy, and the Pseudoparkinsonian tremor are well controlled.

 

Psyc Meds: Forfivo XL 450 mg (Wellbutrin XL), Abilify 15 mg, (Aripiprazole), Eszopiclone 6 mg (Lunesta), Vyvance 70 mg, (Dextroamphetamine) Levetiracetam 2,000 mg (Keppra), Propranolol ER 60 mg (Inderal)
PRN: Lorazepam 1-4 mg (Ativan), Alprazolam 1-2 mg (Xanax), Dextroamphetamine 10-40 mg (Dexedrine), Propranolol 20-40 mg (Inderal), Ondansetron 8 mg (Zofran)

Supps: Multi-vitamin/mineral, Vitamin D-3 2,000 IU, Omega-3-acid ethyl esters 4 g (Lovaza), Fish oil 1-4 g.

Dx: Depression, Insomnia, ADHD-PI, Epilepsy, Dyspraxia, Tremor

I also take allergy and diabetes + it's complications meds.

All doses are a daily total.


#11 Anyone

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Posted 02 March 2013 - 01:45 AM

@anyone - Sunset is most definitely not against the idea of taking more than one AD at a time, and a quick look at her current meds confirms that. What she and I have been trying to get this poster to understand is that mixing two SSRIs/SNRIs is potentially extremely dangerous without direct pdoc supervision, especially since he's already on the max dose of 120mg Cymbalta.

 

Fair enough, although I'm not sure that two SSRI/SNRIs are necessarily that dangerous.  MANY years ago, I was on Zoloft (I don't recall the dose, but I think it was moderate) and Serzone was added as an extra anti-anxiety med, and it helps me a lot, and my pdoc didn't think it was a big deal.  I later was switched from Zoloft to Cymbalta to try to add to my energy level (as most of my cocktail  was and is sedating, and SNRIs like Cymbalta are among the very few meds that can be both activating and anxiolytic).  My Cymbalta dose is definitely moderate, as the OP is on 120 mg and I'm on 60 mg; but my Serzone dosage is the maximum.

 

When adding the Serzone (to the Zoloft I was then on), I wasn't even warned about any risk of combining SSRIs, and it was a very positive addition.  Serzone is an unusual med, but it's basically an SNRI that leans more toward the S than the N, but blocks certain serotonin receptors that are responsible for many SSRI side effects.  I know that because of occasional bad liver problems Serzone is considered somewhat risky, but regardless I've taken two serotonin-involving antidepressants at once for quite a while (probably a decade), even having to change pdocs during their use, and no one batted an eyelash over it.  That said...

 

Geez, all this fuss. Just take a benzo.

 

This is still a valid point.  If the OP hasn't at least asked his/her pdoc if the pdoc will prescribe a benzo (some won't, but others will), then the OP isn't taking perhaps the best step to help with his/her anxiety.  And as someone else pointed out, even if benzos are refused, the pdoc might find a med like Lyrica or Neurontin acceptable.

 

The OP may get such a prescription and still not get enough relief at the levels the pdoc will prescribe, and at that point the fixation on antidepressants would be easier to understand.

 

And BTW - As Bluechick says, Wellbutrin is not an anti-anxiety drug.  It's an antidepressant for people who have trouble caring about anything or trouble finding pleasure in things they'd normally find pleasurable (people who have some degree of what's called anhedonia).  It's great for that sort of use, but it's not an anti-anxiety drug.


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#12 Each Coming Night

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Posted 02 March 2013 - 10:19 AM

Geez, all this fuss. Just take a benzo.

 

Another unhelpful one-liner. Seriously, is this the most intelligent comment you can contribute to the discussion?

 

The OP seems to have major substance abuse issues so I don't think any doctor is likely to prescribe him benzos. An earlier thread he started (since deleted) mentioned that his marijuana habit landed him in hospital with psychosis. In any case, while they do help with anxiety in the short/medium term (and there is a case to be made that they also work long term) I think most of us agree that all other options should be exhausted before benzos are considered for anxiety.

 

@piemachine, you might ask your pdoc to consider upping the olanzapine and lowering the Abilify as it tends to be very activating/anxiogenic for a lot of people.


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