View Full Version : combining antidepressants (cymbalta)

07-07-2011, 08:39
sorry if this isn't the best area for this thread, i value the opinion of the members in, so i'm keen to hear your thoughts...

im currently taking cymbalta for anxiety, depression and for pain.
i'll be facing some very tough times in the next few months and will need help with my anxiety that is only barely being addressed by cymbalta.

i'm not sure how combining antidepressants works, but would there be any advantage to combining another medication to help with my anxiety?
its silly of me to think i can use benzos to fix such a broad problem.

i have tried a few SSRIs and they gave me really bad insomnia, but perhaps as a combo it may be ok?
TCAs are most likely out of the question due to side effects
perhaps other SNRIs may help?

i'm open to suggestions as i have no idea about medication interaction and the effect it would have on a person when it comes to combining antidepressants.

Mr Blonde
07-07-2011, 08:58
Combining antidepressants is generally avoided as it can lead to serotonin syndrome; if the combination were going to be used you would have to be carefully monitored by your prescribing doctors. This risk will exist with most antidepressants of the SSRI, SNRI or TCA classes.

What other antidepressants have you tried? Efexor is one that I have seen scripted in huge doses (300mg+) for anxiety and depression, sometimes with good results.

Are you seeing a psychologist as well? You can get some free sessions under Medicare.

07-07-2011, 09:33
i've tried:

maybe one or two more, not a huge amount, but i had bad results with all, plus some anti-psychotics.

my problem is that cymbalta helps me with my pain, so at the moment i would be very hesitant to give it up.
i'm currently on 60mg, is cymbalta ever prescribed at a higher dose to treat anxiety/depression?
i think i looked into it and couldn't find much info, but i've got to go out atm and don't have time to double check.

i know Efexor can also help with pain in a similar way, but its also true for some of the other antidepressants they gave me that had no effect on my pain.

i'm attempting to get an appointment with a psychologist i saw a month or two ago but may be restricted as it was for a court case through legal aid.
i also hear back about whether i am accepted into the pain clinic next week, which of course includes some psychological help and i'm a bit hesitant to see two people at the same time.

but yes, it is certainly something i will be doing regardless.

Mr Blonde
07-07-2011, 10:41
^ Efexor is an SNRI like Cymbalta is; but with seemingly more flexibility with dosing. I think it could be worth a shot. You might need to get an authority to get larger doses on the PBS though.

07-07-2011, 11:04
thats ok, the pain specialist i'm seeing is understanding when it comes to the PBS and i'm sure he will be happy to discuss Efexor.
hopefully i don't lose any of the positive pain relief properties, but guess i'll find out.

is it much of an issue changing between SNRIs? ie. stopping medication for a period before transferring?

Mr Blonde
07-07-2011, 11:19
^ Usually not, so long as they are using equivalent doses.

Hope it works out well for you. :)

07-07-2011, 11:38
cheers man.
i've done alot of reading and sifting through the horror stories there seems to be some people that get positives out of it, so i'll give it a crack.

07-07-2011, 15:36
Why not think a bit different and instead add some dopamine in there.
Serotonin is not the key to not being depressed as doctors are lead to believe. How often are you depressed while you are high on dopamine agonists?
Dopamine agonists works straight away as well, not maybe in 3 months time, go great with SNRI, tetracyclics and SSRIs.
medications like repreve and pramipexole might help.
I find repreve great at night for sleep, muscle relaxation and euphoria. It works great with avanza for me and works better than benzos for long term insomia. My tolerance has not gone up since 3 weeks after starting it. Also by adding repreve in there you will be able over come SSRI side effects like insomia, twitches and erectile dysfunction. Repreve also potentates opiates and other sedatives.
Tramadol is another option most doctors wont give you and so is lyrica.
Tramdol, lyrica, avanza, low dose bupe and repreve would make a great combo. You would be pain free as well, chipper and happy :)

07-07-2011, 15:53
been down the dopamine path long ago - had no effect on my mood and some had bad effects on my pain.
they also take some time to take full effect once an effective dose is reached.

no doctor will give me any opiates at all (other than tramadol which does nothing)

lyrica had some effect, i have to persuade my pain specialist to do it on PBS, but that doesn't really solve my problem. it didn't seem to help with sleep unless i had quite a high dose and i still needed some xanax.

i don't think you can compare depression to being high on meth or something man lol but it would be nice if it was that easy.

my head is all sorts of fucked up at the moment due to the shit storm i'm going through, during the day is manageable, but alone with my thoughts at night is not so easy.

if anyone had a clearer idea about whats wrong with me, this would be alot easier, but apparently its some big mystery, or its all in my head. so i need to reach a level where i can function without relying on drugs that i will build a tolerance to or that aren't easily prescribed with no actual diagnosis as i don't want to find something that works only to be told i have to stop taking it a month later.

07-07-2011, 16:38
I was thinking maybe avanza (mirtazapine) too, which is a 'noradrenergic and specific serotonergic antidepressant', and can be combined with SSRI's safely. It's sedating (taken at night it really helps you sleep) and I found it really effective for anxiety (SSRI's made mine my anxiety much worse).

07-07-2011, 17:38
can i combine it with my SNRI though?
mirtazapine has no sedating effect on me at all, already tried it for a few days when trying to get on top of insomnia.
without neuropathic pain killing properties, i can't consider it as its the only pain relief i've found in 2 years now :(

thats why i was hoping there was some other med i can combine with an SNRI to increase relief from anxiety.

i feel like i have say 50-60% relief of anxiety but 80% relief of pain. if i'm unable to find a solution in terms of a long term antidepressant style treatment i will have to think outside the box a bit unless a Dr comes to work drunk and prescribes me strong pain killers (thats if they even work).

the effexor sounds on par or better than cymbalta with more scope for increased dosage, so i'll see how i go, but certainly keep the suggestions coming.

Mr Blonde
08-07-2011, 01:27
^ There is an interaction warning between mirtazapine and Cymbalta due to risk of serotonin syndrome, but I will have access to eMIMS in a couple of hours and will look further into it for you and see if I can consult with someone about it who would have experience prescribing these drugs.

08-07-2011, 05:20
Avanza is safely combined with Effexor and scripted alot. Sedating Tc's are Sinneqin and endep ive tried mixed to with other snris but to no real advantage for anxiety personally.