Meds

[Rosa]

sooooo glad I'm back-got another question....Yesterday my doctor took me off Zoloft saying the Cymbalta (which was recently added) is basically doing the same and theres no reason to stay on both. This concerns me slightly. I've gone off Zoloft cold turkey before (not recommended without doctors orders) but I had a heck of a time without it. By going off it again wouldn't I have the same horrable side effects now??? Today is my first day off the Zoloft in many years. It has been my saving Grace if you will over the years. Even though I still get depressed its no where like it use to me. I guess I'm kind of afraid to give it up. As you may recall I'm on lots of meds (see post below as I can't remember them all).
Thanks for your feedback.
Rosa
Got one more question....sorry.... but I've been on Abilify for awhile now and recently (in May) was diagnoised with Diabetes. Since then I have lost the 20lbs I needed to loose and my blood sugar levels have been fine (actually better than fine-in the 80s and 90s) but shouldn't I be worried taking Abilify when I have diabetes??? Do you think this caused the Diabetes? From what I read I'm not suppose to be on this drug with Diabetes. My doctor doesn't seem to be worried about it and keeps prescribing it to me knowing I have Diabetes now.
Thanks again

 

[David Baxter PhD]

Yesterday my doctor took me off Zoloft saying the Cymbalta (which was recently added) is basically doing the same and theres no reason to stay on both. This concerns me slightly. I've gone off Zoloft cold turkey before (not recommended without doctors orders) but I had a heck of a time without it. By going off it again wouldn't I have the same horrable side effects now??? Today is my first day off the Zoloft in many years. It has been my saving Grace if you will over the years. Even though I still get depressed its no where like it use to me. I guess I'm kind of afraid to give it up.

What your doctor says makes sense, Rosa - in most cases, the Cymbalta would be a replacement for Zoloft rather than an add-on. As for "withdrawal effects" (discontinuation effects) from stopping Zoloft, since you have already begun the Cymbalta that should minimize the withdrawal effects; you may have none or at worst they should be less severe. When you stopped cold turkey before, you went from a "serotonin booster" to nothing, whereas this time you have an additional "serotonin booster" in the Cymbalta.

Got one more question....sorry.... but I've been on Abilify for awhile now and recently (in May) was diagnoised with Diabetes. Since then I have lost the 20lbs I needed to loose and my blood sugar levels have been fine (actually better than fine-in the 80s and 90s) but shouldn't I be worried taking Abilify when I have diabetes??? Do you think this caused the Diabetes? From what I read I'm not suppose to be on this drug with Diabetes. My doctor doesn't seem to be worried about it and keeps prescribing it to me knowing I have Diabetes now.

Your doctor is in the best position to advise you, Rosa. Although there is some increased risk for diabetes with these newer "atypical antipsychotics", it's not as if it's a problem for everyone taking them. Your doctor should be able to tell what type of diabetes you have and whether it's likely to have been caused by Abilify or other factors (e.g., genetics), and that puts him in the best position to determine whether for you Abilify presents any additional risk.

 

[Retired]

Rosa,

I believe I can address the first part of your question.

Both Zoloft and Cymbalta are similar types of medications, in that they are both ant depressants and selectively affect the neurotransmitters in the brain thought to be responsible in the illness of depression and anxiety.

There is a difference in their mechanism of action, in that Zoloft affects only serotonin while Cymbalta affects both serotonin and norepinephrine.

Some studies suggest a dual action SNRI has benefits over the older SSRI medications.

Your doctor seems to be going about your medication therapy in the accepted manner.

You are not actually discontinuing the Zoloft, but rather replacing it with the Cymbalta, where a seemsless transition is the way it is usually done.

You may require a fine tuning of the dose, in a week or two, so be sure to report any chanhes you feel or unexpected reactions you experience.

It sounds like your doctor has your best interests in mind.

Sorry I cannot address your second question as I do not have experience in this area.. Hopefully someone else on the Forum can help.

 

[David Baxter PhD]

Often, the physician will start with a low dose of the new medication combined with a reduced dose of the old medication, and gradually taper through a transition phase, i.e., decreasing the Zoloft in 2 or more stages while simultaneously increasing the Cymbalta. I wonder if that's perhaps what was concerning Rosa.

 

[Retired]

I interpreted Rosa's concern about sudden withdrawl:

I've gone off Zoloft cold turkey before

With a 26 hour half-life it will take five to six days to clear out of your system. ... so a medication with such a short half life would drop blood levels at a rapid rate, setting the stage for severe withdral symptoms.

Short half life drugs are a double edge sword, because when therapy is initiated, they provide a rapid steady state, where the amount being ingested equals the amount being excreted.

Rapid steady state allows the physician to quicky evaluate the drug's persormance, and adjust dosage as necessary quickly.

If these meds are withdrawn cold turkey, the person can sauffer sever withdrawl symptoms; but these can be avaoided by following the physician's detailed instruction to taper the dose over several weeks...sometimes up to a month.

Tapering the dose when discontinuing a short half life medication pretty well ensures no adverse effects.

As you have alluded to David, the overlap of Cymbalta and Zoloft all but eliminates withdrawl according to my understanding of the literature.

It should be noted there are certain psychotropic meds (used in treating certain psychatric disorders) that require a full two week wash out period before the next medication is started.

The doctor's instructions must always be followed when medication changes or modifications are made.

 

[Rosa]

Yes I was concerned with going off suddenly but what you've both said does make sense. Don't get me wrong I trust my doctor 100%-sometimes I question myself on the interputation of what he has said and sometimes theres just not enough time to question everything-of course, most of the time I think of these questions when I've already left. I guess, too, it helps to get other opinions. I know nothing about medications and it helps to be able to just put it out there for other people to respond to. The last thing I wanted to do was going thru some serious withdrawl like I did when I suddenly went off it (was one of those not so good ideas I've had in the past) and how hard that was for me. But it make sinse that the new drug with help compensate for this.
As for as the Abilify I guess no one will ever know if it triggered Diabetes in me or not. Thankfully my blood sugars are under control so hopefully I'll be able to continue with that. Oddly enough, its kind of a blessing in disquise, it was quite the wake call to take better care of myself. I really had let myself go-wasn't excercising or eating right. And at least with it being caught I still have the choice to take care of it and not have the problems assocated with it.
Thanks again for your replys,
Rosa

just wanted to add that too, I sometimes feel like a ginny pig just because there are sooo many medications that I have to take.
Rosa

 

[Retired]

I sometimes feel like a ginny pig just because there are sooo many medications that I have to take.

The fact is, Rosa, that physisicans have more choices in medications today than they did a decade ago. This is due to the development of so called "designer drugs" where pharmaceuutical manufacturers develop compounds that are specific to a condition or disorder.

Not every compound is right for every person, so your doctor, being a responsible and ethical professsional will work with you to find which compound is the right one for your body/brain chemistry.

In addition it is often necessary to fine tune the dosage over a period of time until the correct dosage is found for Rosa.

This is never done haphazardly, because your physician has a plan that has been developed through clinical experience and will go through that progression of medications and compounds until the right one is found.

Continue as you are doing...ask questions, lots of questions until you are satisfied you have all the information you need.

 

[Daniel E.]

Regarding Abilify (aripiprazole), there continues to be more reassurance that it is at least relatively safe regarding diabetes risk:

Our results support the reversibility of recent onset diabetes on antipsychotic medication when detected early and followed by a switch to aripiprazole.

A case series: evaluation of the metabolic safety ...[Schizophr Bull. 2007] - PubMed Result (May 2007)

The incidence of metabolic syndrome was 14.3% for 91 placebo patients versus 5.3% for 151 aripiprazole patients (p < .001).

Comparison of metabolic syndrome incidence among s...[J Clin Psychiatry. 2007] - PubMed Result (Oct 2007)

 

[David Baxter PhD]

With ANY medication, including commonly taken OTC medications such as aspirin, ibuprofen, and acetomeniphen, or vaccinations for that matter, there are both risks for at least some people and benefits, so choice of medications really always involves a risk-benefits analysis.

I recall a point about maybe 10-15 years ago when my children were younger and to my surprise the doctor wasn't giving them a smallpox vaccination. I asked about it and he explained that the risk of getting smallpox was now so low that the risk of an adverse reaction to the vaccination was greater than the risk of getting the disease it would prevent. Similarly, one of the medications for schizophrenia, clozipine, is for many people with this illness a "miracle drug", since at present it is the only medication on the market that treats both the positive symptoms and the negative symptoms of schizophrenia. However, there is a small risk of (1) an initial reaction that may cause a sudden potentially fatal drop in blood pressure, and (2) a later reaction involving, if I recall correctly, the production of white blood cells. The benefits to those not susceptible to the adverse reactions are so great that the medication remains commercially available but, in Ontario at least, requires an initial 3-day stay in hospital for observation followed by weekly blood tests for 6 months, dropping to biweekly tests later and then to monthly tests, to monitor white blood cell count. To many people, these risks would seem so serious as to question why anyone would ever consent to taking the drug but the fact is that today it may represent the only hope for certain people with schizophrenia to live a "normal" life, assuming that they are among the majority of patients who do NOT experience the adverse reactions.

 

[Rosa]

Thanks for all the info!!!! And Daniel I really appreciate the info on Diabetes and Abilify. I understand there are risks with any meds and you have to out weigh the risks with the benefits. Clearly few things would out weigh the need for me to try to stop the depression.
So far so good with the removal of the Zoloft from my system. I must say, its kind of nice being able to take a few less pills in the morning. I didn't have alot of faith in the new drug but it appears to be helping me out....it seems to have offset any side effects I would have had from going off the Zoloft.
Thanks for everyones help!
Rosa

 

[Retired]

it seems to have offset any side effects I would have had from going off the Zoloft

Precisely! The new medication took over supplying the serotonin blood levels that would have decreased had Zoloft been withdrawn on its own.

Therefore there were no effects of withdrawal.

It should be stated that if your doctor would have wanted to discontinue (withdraw) the Zoloft without replacing it with another SSRI or SNRI, you would have been given a several weeks in which the dose would have been tapered to gradually reduce the dose to zero.

Tapering the dose is the method used by physicians for the patient to avoid potential withdrawal symptoms.

Glad to hear you're tolerating your new meds well, Rosa.

 

[Rosa]

thanks Steve! I apprecite the info!!!
Be well
Rosa