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  #1  
Old 03-04-09, 09:15 PM
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Cymbalta, Strattera, Wellbutrin, Methylphenidate

I have been struggling with depression on and off for years. After trying several SSRIs and not tolerating the side effects so well I was prescribed Cymbalta for depression. I took cymbalta for ~2 months or so. The first or second week on Cymbalta I noticed that my concentration, clarity, and overall mental ability became extremely sharp. I could do and say what I wanted to with unreal clarity. This effect wore off after a week and later developed into severe tiredness which forced me to discontinue using Cymbalta.

Being intrigued by the short term mental benefits of Cymbalta I began looking into ADHD and soon realized that I have many symptoms of it (difficult to concentrate, mind wandering, difficulty reading, poor conversation skills, etc..). About 6 months after discontinuing Cymbalta I asked my Dr. about trying Strattera for mt ADHD symptoms (they are both NRIs so I thought I might benfit from it). Strattera did about the same for me - 1 week of good clarity and mental focus followed by weeks of continuously increasing tiredness (and no mental benefit). I had to discontinue due to extreme tiredness.

I went to a psychiatrist in November '08 who then prescribed me wellbutrin XL 150mg 1x daily. I took it for about a month and noticed my depression symptoms were managed but I was unsure about my ADHD symptoms. During my followup appointment I asked for generic Wellbutrin SR because it was substantially more affordable. He prescribed 100mg 2x a day. I did the 2x a day for a few weeks but I felt that this dosage was too high as I was having issues with bursts of anger. I moved down to 100mg a day and have been there for the past 2 months. Overall I have an energy that is consistent and allows me to function like a "normal" person.

Having been satisfied with the effects of Wellbutrin on my depression, I began to notice that it was very difficult for me to concentrate. Anxiety is also an issue and it tends to make my thoughts race. I am currently taking college courses and reading is next to impossible for me. The anxiety feeds my poor concentration and it is terrible. It is also difficult to sleep. I called my Doc and asked for something/ anything to help. Due to my need for such a low dose of Wellbutrin my Dr. prescribed a low dose of Ritalin (instant release type - generic) to try it out (5mg 1x daily). I took my first dose this past Saturday noticed a few things. I was able to stay on task and read without feeling anxious, I felt calm and in control. This feeling was marginal compared to my first good experiences with Cymbalta & Strattera. Anyway after a few hours it wore off and I was back to "normal". I took it again on Sunday and the mental boost was about half of what it seemed to be on Saturday. Again I took it on Monday and the mental boost was similar to sunday's effect - nothing to get excited about. Tuesday's dose had little improvement on my concentration.

What I am noticing is that each day I am experiencing increasing symptoms of depression. The Ritalin wears off and the initial comedown isn't so bad but I feel tired until I take it again the next day. I am sleeping really well but it is becoming increasingly difficult to get out of bed. My alertness that I gained with Wellbutrin alone has been replaced with tiredness. I only feel "normal" during the 2-3 hours after taking the 5mg of Ritalin. I am calm overall but feel like continuing may not be the best idea.

I wanted to know if anyone else has had a similar kind of experience with cymbalta, strattera, wellbutrin, or Ritalin and maybe offer some guidance as to what might be a good approach to discuss with my Dr. Thanks.
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Old 03-04-09, 11:01 PM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

I would say that yes ritalin helps , but when it wears off it can make you feel out of it. I'm not sure what one can do about it except for take another dose or increase the initial dosage?
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Old 03-04-09, 11:22 PM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

It could be that the short acting nature of the IR destabilizes your mood. I have bipolar and so am not the best comparison, however, maybe there is some similarity with mood disorder in general. I was not diagnosed with ADD until I stabilized for a few months. We started with Ritalin IR, 5mg 2x/day. At first, I got a very slight pick up which slowly wore off, then I got the same with the second dose. By the third day, I did not get a pick up. Instead, my mood started to yoyo a little. I'd feel fine, then get some depression tugs. I'd take the second dose, and same thing leading to loss of energy and some apathy which lasted until I took another dose. I quit about five days in because this was like big red warning flag for me. I switched to Concerta, which is long acting Ritalin. My mood was find on it, however, a few days in it started making me tired. (A lot of coffee makes me tired, so eh, not so surprising.) Now I am trialing Adderall XR and so far it is going better.

I think you should call your psychiatrist tomorrow and explain what is going on. If you energy stays low and your mood goes low, you may want to retry a higher dose of Wellbutrin before you mess with stims. Mood and energy are more important to maintain than dealing with inattention except for the few whose mood is driven by ADHD.
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Old 03-05-09, 12:10 AM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

I'd have to say my experience with Ritalin has been similar to yours. My mood does tend to yoyo from "ok" to depressed. The depressed feeling is different from what I would call my "typical depression". Its almost similar to the effect of caffeine. If I don't have any caffeine for a few weeks and then I have a can of soda I experience inhanced mental ability. When the caffeine wears off I become highly irritable followed by a short duration mild depression the next day. If I have caffeine again the next day the beneficial effects are maybe 1/3 of what the initial caffeine dose brought.

Is it possible to achieve the initial benefit I experienced with cymbalta and strattera with medication? Or am I expecting too much? Should I only take Ritalin as a situational medication (not every day)? I know what my brain is capable of - I just wonder if it is possible to clear the fog for a sustained amount of time.
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Old 03-05-09, 01:38 AM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

I'd give the extended release Concerta a try. If that isn't so good, I'd try Adderall XR before giving up. Then, too, you could figure which might help on an as needed bases the best. And, I'd stay on top of the depression. Depression itself can cloud thought, impair memory, mess with executive function, do all kinds of ungood stuff.
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Old 03-05-09, 02:31 AM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

The metabolism of Strattera occurs via a specific enzymatic pathway*. About 7% of Caucasians are deficient in or lack the ability to create this enzyme.

Because the compound isn't broken down it remains in the body for an extended period of time. As additional doses are taken day after day the amount actually increases.

It is conceivable that Strattera would work for you if it was taken less often or at a lower dosage.

That's just a thought...something to look into if you wanted to re-try it. There may be cases where people had success doing that.

Cymbalta is metabolized by the same pathway but it has secondary pathways. But it may have been that you have similar reaction (though over different time periods) to both medicines for a related reason regarding metabolism.

Or it may relate to some other changes that occur after the initial exposure.


________

* "eliminated primarily by oxidative metabolism through the Cytochrome P450 2D6 (CYP2D6) enzymatic pathway"
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Old 03-05-09, 09:44 AM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

howdy howard. long time no chat!

I've been decreasing my strattera a lot the longer I've been on it. I just don't need nearly as much as I used to when I was first starting on it.

it does build up in your system. maybe try lowering your dosage?

for example, I was up to 100 mg / day at one point.

now I'm at 40.
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Old 03-05-09, 07:54 PM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

Thanks for the advice.

I'm not having any significant issues myself...MeestrGoat had some positive results for a number of days but then he hit a wall of sorts.

Quote:
MeestrGoat Strattera did about the same for me - 1 week of good clarity and mental focus followed by weeks of continuously increasing tiredness (and no mental benefit). I had to discontinue due to extreme tiredness.
I was thinking he may have a metabolic issue.

(?)
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Old 03-05-09, 11:49 PM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

Starting the wellbutrin in November I did feel that 150mg was appropriate. But the longer I took it the less I felt I needed. Wasn't sure if this was related to quantity of sunlight (SAD) or something else.

Today I took the 5mg Ritalin tablet and cut it in half. I took 2.5mg at 10am and the other 2.5mg at 1:30. I did not get jittery like I do at the full 5mg dose. My focus wasn't all that great but I was able to work on a single task. This feeling has continued all day even at 10:30pm and my last dose was at 1:30pm. I find that I do not respond to others around me - almost like I am ignoring activities that I usually find stimulating. To be honest - since I started Ritalin 6 days ago I have become more and more emotionless. I don't get rushing thoughts (good) but I miss my typically colorful self (singing, making jokes, having feelings, etc..). It seems like the Ritalin affects me for an extended period. Or maybe it is something else. All I can say is I am definitely different from what I was 6 days ago. I almost feel like a robot with no motivation at this point, like it takes actual effort to have a conversation or to even laugh. I'm going to have to ask coworkers about my behavior to see how they describe it. It's like having no emotion similar to when one is very depressed without the sadness - sort of.

I go see my doc in 3 weeks. I could call him now but I feel like I should fully understand what I am feeling before I make judgement on a medication. If 5mg ritalin makes me jittery - does that mean it is too much? Should I continue with two consecutive 2.5mg doses to see how I adjust to it? Should I skip days and see if there is improvment? What kind of metabolism issue could I have and what effect would that have on treatment?

Something I forgot to mention now 3x (ironically) is that the Wellbutrin seems to have a significant impact on my memory (another reason I kicked back to 100mg 1x daily). I can literally take a drink from the fridge, place it on the counter, grab my pills, and then go looking in the fridge for my drink (which is still on the counter). This was worsening on 150mg and has slightly improved on 100mg. Metabolism issue?
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Old 03-06-09, 01:36 AM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

Regarding Strattera -

Atomoxetine is is eliminated primarily by oxidative metabolism through the cytochrome P450 2D6 (CYP2D6) enzymatic pathway and subsequent glucuronidation. Atomoxetine has a half-life of about 5 hours.

A fraction of the population (about 7% of Caucasians and 2% of African Americans) are poor metabolizers (PMs) of CYP2D6 metabolized drugs.

Atomoxetine is rapidly absorbed after oral administration, with absolute bioavailability of about 63% in EMs and 94% in PMs. Maximal plasma concentrations (C max ) are reached approximately 1 to 2 hours after dosing."

Atomoxetine is metabolized primarily through the CYP2D6 enzymatic pathway. People with reduced activity in this pathway (PMs) have higher plasma concentrations of atomoxetine compared with people with normal activity (EMs). For PMs, AUC of atomoxetine is approximately 10-fold and C ss,max is about 5-fold greater than EMs.


~ Eli Lilly, Prescribing Information

****

Generally speaking, if you are a poor metabolizer the drug becomes more readily available in its initial form in the blood (or plasma). That is is generally what is meant by the term "bioavailability."

Secondly, it remains in the body for a much longer period of time. That is generally what is meant by AUC ("area under the curve" - or the amount present multiplied by the length of time present.)

The C ss,max relationship says (I believe) that if two individuals are given doses - such that the new administration is exactly equal to the amount eliminated - over time (eventually) they will reach some steady state and have a maximum sustained plasma concentration (at some level). Apparently it is about 5 times as high a level for "PM"s compared to "EM"s.

***

In terms of dosing, Lilly does not expect "PMs" will go to doses above aprox 25 - 50mg. per day (based on weight), but they say it is possible if the drug is "well tolerated". Still, even if well tolerated, they use an upper limit of 80mg. per day, as opposed to 100mg per day for those adults.

On the other hand, they don't seem to imply that they think it will be effective at doses lower than that initial dose (as that is also the recommended starting dose for "PMs").

It could be that you are in a certain percentage of the population where a 18mg or 25mg per day dosage may be optimal (?).

Or it could be that you just don't respond well to SNRIs over a any extended period of time...
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Old 03-26-09, 11:09 PM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

So I have not taken the Methylphenidate for a while. I only tried it for a week and I became severely de-motivated and zombie like. After stopping the methylphenidate it took ~3 days to return to "normal".

My doctor gave me an Rx for Concerta 18mg today. I am a little leary about trying it as I can't afford another bout of severe unmotivation. How many days should I give the Concerta before passing judgement? I'm still taking 100mg Wellbutrin 1x daily.
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Old 04-01-09, 09:54 PM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

I'm unclear on your cymbalta results , isn't cymbalta theoretically perfect for adhd depression and generalized anxiety? I would think that since it is an snri that the ne effect would be the same as wellbutrin only with the serotonin kick. I don't understand how it makes one tired after duration of taking the med , shouldn't it do the opposite? I am trialing cymbalta with my concerta now... I've been on wellbutrin +concerta and it helped with depression and motivation but I had to stop because I just felt like I was mentally stuck after awhile... I really hope the cymbalta helps,.
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Old 04-02-09, 10:10 PM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

I am a little confused by it as well. Both Cymbalta and Strattera eventually made me coma-like. Cymbalta did seem to relieve any aches and pains I was having.

I am currently taking 100mg wellbutrin and 18mg concerta. This combination seems to be working out rather fine. The concerta is helping to a point but I am finding that it does not work long enough for my needs and it seems to be just shy of an effective dose (helps but could be better). Because of this I have tried extending its effectiveness with IR methylphenidate. I started the concerta last friday.

Yesterday I took 18mg concerta at 7am. I could not function at all (unusual) so at 9:30am I took a 5mg IR methyphenidate. I was good to go for 2.5~3 hours. Honestly this was probably a little more than I needed since the two were overlapping and I was a little too chatty. I was then ok for most of the day until about 7pm. Writing a paper was extremely difficult - I could focus but could not think. I slept really well this night.

Today I took 5mg IR meth at 6:30 am. I felt great from 7am on. I took the concerta at 9:30 (to try and make a smooth transition) and felt just shy of great until ~7pm. I am struggling in the evenings because this is when I do schoolwork. So at 8pm I took 2.5mg of IR meth so I could do some schoolwork. It isn't enough to make me real productive but I can at least function.

What kind of schedules have others tried with the Concerta + IR Methylphenidate supplement? I need about 16-17 hours coverage. The transition from 5mg IR to the concerta went really well today (and smooth) - i'm not sure how to time the evening. Anyone with a similar experience?

Which works better? IR -> concerta -> IR (or) concerta -> IR -> IR (or) IR -> IR -> concerta
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Old 05-13-09, 08:28 PM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

I stumbled across this post and thought it would be necessary to reply.
I started taking 30 mg Cymbalta in November of last year. I didn't notice any difference until I started taking 15 mg Ritalin 3x a day, at which point I experienced pretty much the same thing--Increased mental ability and a complete cure of my depression, ADD and social anxiety. The Cymbalta would work for me as long as I was taking the Ritalin too. This went on for six months (a MAJOR milestone for me, most meds such as wellbutrin only lasted a few weeks) although I constantly had to up the dosage during the course of that time. When I finally reached maximum dosage and the combination had stopped working, I started looking for other alternatives. So far, Wellbutrin and Zoloft have no effect. I'm thinking about taking Effexor or Strattera next.

I am still trying to figure out what exactly caused this phenomenon, and how I can make it happen again (without waiting for 6 months for my immunity of cymbalta to wear off), and I'm wondering if anyone has had this happen with other drugs.

Just throwing in my experiences. Any feedback would be appreciated.
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Old 05-13-09, 09:32 PM
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Re: Cymbalta, Strattera, Wellbutrin, Methylphenidate

its strange to me that you have had these results . cymbalta is supposed to be are med that duration of effects and results are not supposed to be effective and then loose it's positive benefits. Maybe you need to increase the overall dosages of ritalin or move to adderall? I am just starting cymbalta , does the drowsiness subside? I have heard of many people being on antidepressants at the same dose like zoloft for several years without an increase-
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