02/03/18 Saturday

All the SSRI's and SNRI's have potential for brain zaps when skipped or withdrawn. Every patient says "this going to sound weird....but I felt something like....like..." and I say "brain zaps?" and they say "YES!"

Would agree that the SNRI's (Cymbalta) have slightly more withdrawal symptoms associated with them but just slightly. I think Devon has experience with fluoxetine (Prozac) tho I don't know if that is coloring his perspective. Plus, prozac was the first of its ilk -- the big gorilla of modern antidepressants/antianxiety meds and everything gets compared to it.

Prozac has a super long half life so it can be stopped and it will "self taper" But, it stands alone. All of its kindred SSRI's have short 1/2 lives and have to be tapered in a manner similar to cymbalta.

I don't have worries about Cymbalta and I know our psychiatry team doesn't have worries about it. A couple of the SSRI's do have cautions on them for heart effects which can be exacerbated by other things that may or may not apply to you. We use Cymbalta preferentially in other situations, too.

With any of these meds, they should be titrated up slowly- there are frequent start up side effects that are temporary but are more manageable if you give the body a chance to get used to them.

One potential start up side effect happens to be anxiety (how rude!) so if you notice an uptick you aren't crazy. (I don't say "crazy" in my professional world but I know you know I don't mean it) It will pass but the dose might need to be adjusted downward for a few days to help get you by it. (The dose would be increased later)

Just ask if you are wondering about anything. Serotonin receptors are located all over the body and the temporary side effects can come from any one of them. I spend several hours every week making phone calls to patients who started SSRI/SNRI's 10-14 days earlier.

Sorry to be so wordy.

No, wordy is good. My prescribed dose is 30 mg. Any special way I should titrate up to start with i.e. take every other day or every third day at first and slowly add on days?

We usually start with 30mg daily, avoid skipping unless otherwise directed. (Skipping every 3rd day might be helpful if issues but wait for significant issues. Skipping can reset you back to starting point)

Edited to add, even the pharmacists are supposed to remind patients that medication is just one piece of their tool kit. Best results come to those who also add in counseling AND do nice things for themselves (hobbies, alone-time, friends, sleep, exercise, massage etc etc etc etc)

Paula, a friend with SAD got day light bulbs on line and replaced her lightbulbs in her home. They helped tremendously, and I believe, at least several years ago when she did this, they cost a lot less than one of the light therapy boxes. Also, they were everywhere in the house, so she didn't need to stay in one place to get the benefits.

I was thinking late last night when reading everyone's entries on the board that we certainly have a lot going on - each of us in our individual, yet in parallel ways, is dealing with some type of stress: death, illness, metal uncertainty in loved ones, new lives, work... So I started to wonder if one of the symptoms of obesity is a predisposition to be susceptible to stress. Something to continue to think about.

Managed to find Del's obituary by going to Ann's FB page. It did not come up on my feed. Wonder why? It is a lovely obituary. While factual, Ann's writing revealed an insight into Del's personality. Not going to lie, the man led a sexy life. Well, it was to me anyway. A bit of a "bad boy", highly intelligent, and focused on doing good in the world. Add rugged good looks to the package and, well.... A lovely tribute to Del without a single superfluous word (something I am working on learning!)

Weight was suddenly back down 2.5 yesterday and stayed that way today. I guess that's good. I'll take any win right now.

The conversation about intermittent fasting is interesting. I have no comment really. I know a lot about the theory behind it, but I don't think it's for me. My brother is doing a Ketogenic diet. He had two glasses of "dry" red wine with dinner last night, but refused to eat the grilled carrots on his plate because they are not "Keto". Sort of, kind of, almost lost my cookies over that. I did speak my mind, but REALLY? WTF? It's like all those newbie VSGers who wouldn't dare eat a ******g piece of toast, but suck down a couple glasses of wine. I have never understood why wine is okay but bread or chocolate is not. Empty calories is empty calories....

I HAVE AN ENTIRE DAY OF NO GROOMING! Our new mattress is being delivered between 4 & 6. I'm going to get a pedicure today, too. Maybe even a massage. Oh joy!!!!!!!

Devon, you described my husband to a T: Gorgeous, sexy, and a good, sweet man. I'm so glad the obit painted for you that image of him.

Devon, the superfluous words issues is a big one for me. I have an Edith Bunker personality - needing to tell every single detail, and boring others at the same time. I have never felt what you write has unnecessary words, details, etc. Your writing skills are extraordinary. When reading your posts, I can literally feel the feelings you describe. It is usually quite powerful!

Weight 165.2

Good morning everyone! Love the dance picture, Liz! I have a very close friend who lives in a huge retirement city here in Orange County and they have lots of dances there with local cover bands. We've laughed at the 5:30 start there too, but she says they are a lot of fun and people dance the whole time as well without a care. She draws the line at one weekly dance that starts at 4. That one attracts an "older" crowd (she's 74)...

Tonight I'm headed to the Performing Arts Center to see Kristin Chenoweth. She's amazing, can't wait. But now I need to walk the beast around the neighborhood. We didn't get much of a walk last night as we came across a few coyotes in the park and I opted to turn around. Fergus is big so I don't think they'd bother us, but why take a chance?

PS - I finally finished the Lego set. So much fun!

Awesome Leggo village. I want to play with it. DS

Me too! Though I must admit I was thinking, now what the hell do I do with it?...