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New Snri - Fetzima


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#1 dante1231

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Posted 10 December 2013 - 10:59 PM

Been doing a little research on the new drugs, particularly Fetzima and Brintellix.  Fetzima is an SNRI, Brintellix a SSRI.

 

I have been on Cymbalta (first 60mg, now 120mg for quite some time) for forever, it seems, with other meds joining in at various times since then.  Risperdal for irritabiliy and irrtational thoughts, BuSpar then Xanax for panic and anxiety, Abilify to replace risperdal (huge mistake, I almost lost my mind).  Back to risperdal.  Bupropion at 300mg then to 450mg as an add-on.  Most recently Adderal 20mg (now 40mg) for adult ADD and related issues. I also take meds for high bp, high cholesterol, and hypothyroidism.  All this leaves me with borderline low functioning kidneys, so I am supposed to drink 80-100oz of water a day.

 

Earlier this year, my insurance decided to stop covering Cymbalta (I heard that a lot of people were cut off).  So I went to Effexor 450mg.  Did not work.  Thankfully insurance changed course and decided to cover Cymbalta again. Those two months were hellish.

 

Now we are on the cusp of Cymbalta going generic, which will bring my price down from $125/90 days to $20/90 days.  My depression is managed, but I am still relatively unhappy and don't enjoy life as much as I would like to.   I also have breakthrough depression which affects my overall self worth, job performance, sleeping, motivation, thoughts about the future, and some suicidal thoughts (but nothing serious).

 

So along comes Fetzima, a new SNRI.  I have not seen any reviews or comments on it, so I assume it is very, very new.  Price with insurance will be $80-$100/30 days (no pricing given for 90 days).  I am curious about it, but I don't want it to be another Effexor nightmare where I have to come running back to Cymbalta when it fails.  But then again, it could be just what I need.  The price is pretty high, but I could probably manage it if I really tried.  I see my pdoc next week, I will bring it up and see what she has to say.  But I wanted to post here to see if anyone has started taking it or knows someone who has.

 

Thanks.



#2 PeaceBeWithU

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Posted 08 January 2014 - 06:23 AM

Hi Dante1231,

I have a very simular story to yours.  Except for me Effexor was my life saver, it's the only thing that ever really worked, and at that it only worked a little, for me cymbolta did nothing, and most the doctors I know what even prescribe it as they feel the Effexor is better, but everyone is so different.  I am taking a lot of the same meds you are or simular, need the stimulants to keep me awake.  My life is a nightmare, and after 15 plus years it's a real struggle.

I saw Brintellix advertised, though I thought it was a SNRI not a SSRI, any ways I was going to suggest it to my doctor but he gave me Fetzima, I am desperate and will start tonight.  Lucky for me I can come off Effexor very fast, with no side effects.  I have been out of work for a week now, and struggling with the suicidal thoughts since around christmas and I haven't been functioning much, not that I am functional in any way.  I just get by, and it is painful and a struggle.

Feel free to email me if you would like updates on how it is working out, or anyone for that matter.  ECT will be next if this doesn't work, as I have had the TMS and it didn't work for me, and I have to do something as I have missed 15 plus years of living but the ECT scares the crap out of me, I have to be honest.  I am not looking forward to having to do that.  I sleep all the time, and at night my mind races, I take clonapin, ambien, valium, and deplin, which is very expensive but my doc gives me free samples, thank god for him, he has been my rock, I don't know what i would do with out him

I wish you wellness, and sometimes it's good to know that you are not alone, I know that just reading your write up, I felt like someone else was out there and I wasn't the only one, and found it comforting, thought I wish you didn't have to go through it, as you know it is hell.  I hope you the best and you are in my thoughts.

 

Peace my friend



#3 ABYSS

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Posted 17 January 2014 - 02:56 PM

Peace be with u, I can relate as I have a deep treatment resistant depression with idealogy.  I have had tms and ect.  TMS worked for me when it first came out for 6 weeks I had 1 maintenance treatment and nothing else happened the doctor didn't reccomend trying more.  I hear there is new stuff for tms coming out different settings synchronized meaning trying several different parts of the brain versus 1 and 2 coils instead of 1, i may go this route at some point its just so hard because you have to do 6-8 weeks and i have to change my work schedule and drive over an hour to get to the nearest place and no promises.  ECT did nothing for me except turn me into a zombie and **** my memory some of it has come back but im still not the same as before.  If you decide to try it good luck, I did 30 treatments both unilateral and bilateral and augmented with lexapro and zyprexa.



#4 ebmosier

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Posted 18 January 2014 - 10:23 PM

Hey dante,

 

My doc just started me on this after Pristiq wasn't doing anything for me. My first two doses were 20mg, then 40mg for two days, then 80mg for the next month. From what I've read, it's gotten positive reviews (sorry, I can't remember where now, though), but I'll keep these forums updated. I'm anxious to see how it works, since I've had a long-running, mild, treatment-resistant depression. Fingers crossed!



#5 dante1231

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Posted 20 January 2014 - 05:56 PM

Thanks for the responses, guys.  Peace, can you provide us with an update?

 

I saw my pdoc last week and expressed frustration that my meds are not working.  At the previous visit (the one I mentioned) we really didn't talk about trying something new, but this time she did suggest that if I want to try something new, she is willing to work with me.

 

The price on Fetzima has come down a bit, it is now $71.72 a month.  Still no price for 90 days.  If I try to force the Caremark website to do 90 days, it spits back an error - plan limitations exceeded.  Examples could be quantity or days supply.  And then it gives me a bogus price of $100/3mo, just like it does with Brintelliix (if I force it to do 90 days,but if I don't put in days supply it will give me a correct 90 day price).

 

Brintellix has been recently mentioned as helping with cognitive functioning, performing better than placebo and another drug (forget which).  This sounds very appealing to me, but again, price is a huge issue.  1mo is about $77, 3mo about $205.  If there was only some way to be more certain that it would be more helpful than Cymbalta, I would go for it. I am in the process of declaring bankruptcy, so I will have some money freed up after I get through that, because I have no other big obligations like mortgage/rent or a car payment (though my car is a 2001, so it could go or become too expensive to repair at any time, I think).  And getting better would help me land a better job - I make ok money, but I am at the complete bottom of the ladder.  I had a good phone conversation with someone in corporate the other day, he was really impressed with my thorough knowledge, and suggested I apply for a job like his... but this damn depression holds me back, some days I just feel like a big pile of crap, don't want to get out of bed, go to work late, have to end up working late to make up for it, and the cycle repeats itself.  You can't be a corporate type and have issues like that.

 

I am hoping at least one of these new drugs gets on the formulary or becomes more affordable soon.  I was holding out hope for Viibryd being my next alternative, but I don't think it is really helping that many people.  I wish Forest labs would at least offer some sort of free trial pack for Fetzima.


Edited by dante1231, 20 January 2014 - 05:58 PM.


#6 dante1231

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Posted 20 January 2014 - 05:57 PM

Oh, and my pdoc suggested I start taking Sam-E, but it's OTC and $40/mo.  Ouch.

 

I've also done some reading and Brintellix and Welbutrin don't apparently get along well, so you have to take a reduced dosage of Brintellix until you stop taking the Welbutrin.  Sorry to derail the thread, but I wanted to share.


Edited by dante1231, 20 January 2014 - 06:04 PM.


#7 Sayonara2013

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Posted 22 January 2014 - 04:15 PM

Just started Fetzima yesterday.... I wanted to try because I don't want to deal with the insurance override forms, every 90 days for Cymbalta (generic is not working for me).  I tried the generic Cymbalta with 14 name brand capsules left  and switched back to name brand after a difficult 10 days of generic.  Unfortunately, I ran out of name brand because Express Scripts took 22 days to approve their form and attach it to my benefit record.

I saw the Doctor yesterday and we discussed Fetzima.  I was already back on the generic for 9 days so it made sense to try. 

Day one is twitchy and I had the pounding headache & nausea because the sample packs started with 40 mg and not the recommended 20 mg initial dose for days 1 and 2 - I should have broken the capsule open and divided the dose.  I will keep at it, because the norepinephrine also helps with my Fibromyalgia.  I know that Forest Pharma separated Savella and Fetzima into 2  patents, one being an isomer of the other.

 

Fetzima needs a prior authorization but at least that will be for a year until it becomes a tier 1 drug on the formulary.



#8 LoveMissesG

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Posted 27 January 2014 - 10:39 AM

I started this antidepressant three days ago. It gives me a jittery feeling & I have a pulse of 101 while sitting. On the upside, it's helped my head pain, cleared my brain fog & my depression. I'm weighing the pros & cons. Anyone else on this antidepressant? Sent from my iPhone using Tapatalk

#9 ABYSS

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Posted 27 January 2014 - 06:56 PM

DONT DO ECT!!!!!!!!  I just started Fetzima to early to judge on day 1 I'll let u know later.



#10 Sayonara2013

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Posted 27 January 2014 - 08:23 PM

I started on Tuesday with Fetzima, today will be day 7. The headaches stopped by this past Saturday.The brain fog and lack of energy is gone but has been replaced by what feels like agitation

Other posters have described it as "edgy" but  to me, it feels like mania and I've been diagnosed as bi-polar which does not have extreme manic symptoms.  I have to hold myself back and not snap at people  - or make poor business decisions. I'm still twitchy and my skin feels crawly & itchy, but it's too late to turn back to Cymbalta.

The twitching, fast heartbeat, blood pressure,  nausea, and  agitation is the serontonin syndrome described in the medication guide.  When I checked Fetzima for interactions with my other 2 medications and vitamins, it seems to interact with everything, even vitamin D and B.  I contacted my Doctor and am monitoring the symptoms.

 

I've isolated myself as much as possible so that I don't tell someone off or make a decision that I will regret. Will make a decision on Friday or Saturday of this week about this med.



#11 ABYSS

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Posted 30 January 2014 - 07:48 PM

On the fourth day and having a tough time no problems with the first 2 days with 20m then the 40 really started to hit me today very flighty at work had a very hard time functioning and the anxiety and headaches are ridiculous, this sucks.  Getting so sick and tired



#12 Sayonara2013

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Posted 30 January 2014 - 09:52 PM

I gave up yesterday - I was cutting the 40 mg capsules in half for 2 days.   I was anxious and felt awful.

  I just entered this on the Cymbalta topic:
 

http://www.depressio...-2#entry1042919

 

I went back to Cymbalta yesterday - took the Fetzima for 10 days. 
 
My blood pressure went sky high (180/90) and I had racing thoughts, sweats, headaches,  twitching, itchy & crawly skin, fast heartbeat, blood pressure,  nausea, and  agitation ias described in the  serontonin syndrome section of the medication guide.   I felt like a crazy squirrel that’s running from tree to tree.   I had gotten thru the nausea and the headaches after 4 days but I could not deal with edgy, hypomanic side effects.  
 
Most of the patient  discussion boards have described Fetzima as making people feel edgy and manic  - here’s a sampling.   It’s how I felt and I felt empowered to tell people off, so I realized it was making me hypomanic. I tried to isolate myself to get thru it but found that I started talking to myself, just to get the racing thoughts out of my head.

  • “Yeah, my first two days of the 20mg Fetzima,  I was on a fast bus to Crankytown.”
  • “Started at 20 mg for two days, then up to 40 mg. The first day or two I was extremely manic - couldn't sleep, racing thoughts, nausea. I held on because I so wanted it to work. Now it's almost 2 weeks later and I feel more energized. I don't need to sleep 10-11 hours a day.  I've stopped taking my second dose of tramadol in the afternoon as it made me too hyper and I couldn't sleep. Am I less depressed? I don't know. Sometimes I feel like I'm outside of myself - calm and distant. It's an improvement over the blackness so I'll go with it and see how it works out.”
  • “Hello, I just wanted to pop in and say that I just started taking Fetzima on Dec 24th.  I started at 20mg and am now on 40mg.  I had been taking Effexor and came off of it slowly to start the Fetzima.  For me, it has had its pros and cons.  I think it has been helping me feel a little more like myself, less sad/anxious/guilty, however, I believe it is making me VERY edgy.  I am a very calm laidback person, with a lot of patience.  I work with children, and I have a toddler of my own, I am a nurturing person.  But lately I have been mean, short, and testy.  It has given me much more energy, and this is coming from a person who had to take two naps a day, just to take care of my child and make dinner in the evenings.  So much so that I wake up at night feeling fully rested.”
  • “Started taking 40 mg of Fetzima for a week and just started taking 80 mg yesterday.  I have been severely nauseated plus I have been 'edgy' and have had tremors as well.”

Fetzima pushes the norepinephrine reuptake harder than the serontonin reuptake, which stops that Cymbalta brain zap feeling - but it didn't help with my fibromyalgia and feeling shaky & twitchy is no way to live.
 

Levomilnacipran is indicated for treating MDD in adults and is unique compared with other SNRIs because it is relatively more selective for norepinephrine reuptake inhibition (NRI) compared with serotonin reuptake inhibition (SRI).1 In vitro studies demonstrate that the drug has >10-fold greater selectivity for norepinephrine reuptake inhibition than it does for serotonin reuptake inhibition, compared with duloxetine or venlafaxine.2

Levomilnacipran’s exact mechanism of action is unknown. Similar to other SNRIs, it binds with high affinity to the serotonin (5-HT) and norepinephrine (NE) transporters and potently inhibits 5-HT and NE reuptake. Levomilnacipran lacks significant affinity for any other receptors, ion channels, or transporters tested in vitro.2 It differs from other SNRIs such as venlafaxine and duloxetine in having higher selectivity for norepinephrine vs serotonin reuptake inhibition. In vitro studies demonstrated a 2-fold preference for NE over 5-HT reuptake inhibition.

 

It's back to Cymbalta, brand name for me, no more experiments.  If you're offered a Fetzima prescription, do your research.  It might not work as well as Cymbalta for you.

 

 

 


 



#13 ebmosier

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Posted 30 January 2014 - 10:15 PM

I've been on Fetzima for two weeks now after some hassle with my pharmacy. I started on 20mg for two days, then 40mg for two more, and now I'm on the 80mg. I did have nausea the first weekend, though I chalked it up to my multivitamin, which can make me nauseous sometimes. And the racing heartbeat! I usually have very low blood pressure and a slower resting heart rate, but it was pretty fast after I'd just started. It's down to 84 now; still a tiny bit higher than my normal heart rate, but at least it's down.

 

The main thing I'm noticing (and this could just be transitioning to a new med) is that I'm just totally out of it. I'm even more of a "zombie" (going through the motions, no real attachments, and absolutely not focused - general brain fog-type stuff) than I have been on other meds. I'm really hoping this clears up and that I eventually feel like myself.


Edited by ebmosier, 30 January 2014 - 10:16 PM.


#14 LoveMissesG

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Posted 31 January 2014 - 04:26 PM

I stopped taking it. I chewed my family out like never before & it felt like I was on the verge of having a heart attack. No thanks! Sent from my iPhone using Tapatalk

#15 Sayonara2013

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Posted 31 January 2014 - 06:13 PM

I feel like "me" again, and it was immediately after I stopped Fetzima. The first day was like turning on a light switch.  I've been on Cymbalta for 2 days and there is no more anxiety, frustration or hypomania (racing thoughts, snapping at people, etc)

I'm sorry if I sound like a robot or computer, but I've learned that I have to understand what my medications are intended to help.  If you're like me, you started taking your meds to feel better and if it worked, you were happy. When I start to feel crappy, I want to know what happened.  I hope this helps anybody who tried Fetzima and didn't like the feeling of being on the brink of losing your temper and patience during every moment that you were awake.

 

This article was a good start for me:   http://www.pharmathe...-for-depression
 

 

In July of 2013, the FDA approved a new serotonin norepinephrine reuptake inhibitor (SNRI) Fetzima (levomilnacipran) for major depressive disorder in adults only. The efficacy of Fetzima at once-daily doses of 40-120mg was established in three randomized, placebo-controlled studies in adults with MDD.

Fetzima is essentially an isomer, or put more simply, a clone of the SNRI Savella, which is approved for the treatment of fibromyalgia. The interesting thing is that Fetzima is not approved for fibromyalgia and Savella is not approved for depression. Go figure. Round up the usual suspects when it comes to the side effects of Fetzima – nausea, heart rate increase, palpitations, erectile dysfunction and other associated SNRI side effects.

There’s nothing new or novel here. Just another drug – in this case Savella – that has undergone a makeover to be marketed for depression.

The snail’s pace of neuroscience continues to hamper pharmaceutical companies in their quest to develop truly novel agents. What we don’t need is yet another SNRI poised to fuel oppositional tolerance, which places the brain in a fighting position to counter the effects of artificial serotonin and norepinephrine manipulation rendered by these antidepressants.

 

The words that I highlighted in red caught my eye, so I kept looking for info. I had an idea of what "oppositional tolerance" meant because my Doctor had explained it to me as "Fetzima  creates a serontonin and norepinephrine imbalance which favors norepinephrine not serotontin. "

After I searched, I found an article which  explained oppostional toloerance in more clinical terms  and it  may explain why some of us started becoming anxious and snapping at people.  Our brains were out of balance and the serontonin and norepinephrine imbalance made us feel yucky.  

 

Fetzima caused "brain-fighting"  that Dr Giovanni Fave described in 1994 as "oppositional tolerance".

 

When you read these notes, remember that Fetzima lowers serontonin and increases norepinephrine levels in the brain:

 

1.   As a stress hormone, norepinephrine affects parts of the brain where attention and responding actions are controlled

 

A.   Along with epinephrine, norepinephrine also underlies the fight-or-flight response, directly increasing heart rate, triggering the release of glucose from energy  stores, and increasing blood flow to skeletal muscle.
 

B.  Epinephrine and norepinephrine,  are also called adrenaline and noradrenaline, two separate but related hormones secreted by the medulla of the adrenal glands.  
 

2.  Serotonin is a hormone found in the digestive tract, the central nervous system, blood platelets and the pineal gland (deep at the center of the brain).
      It is also known as 5-hydroxytryptamine, which is often abbreviated to 5-HT. 

 

A.  Serotonin cannot cross the blood-brain barrier. Therefore serotonin that is used inside the brain must be produced within it.


B.  Serotonin's effects on a range of functions tend to be inhibitory. In other words, it reduces appetite, sexual behavior, and suppresses pain perception.


C.  According to researchers at the absence of serotonin has been associated with greater aggressive behavior. They say that serotonin levels have been correlated with higher levels of irritability, impulsivity, aggression, disordered eating, and sleeping problems.
 

I think "2C" sums up why some of us didn't feel well while trying to use Fetzima.  I truly hope it  helps some of you.

 

___________________________________________________________________________________________________

This is the link to the article which describes how Dr.  Giovanni Fava and other practitioners had observed that antidepressants seemed to worsen the long-term course of depression. 

http://www.psycholog...rdive-dysphoria

Dr Fava used the term "oppositional tolerance" for what was caused by medications. I'm going to talk to my Doctor about the last 2 sentences  in the excerpt below. 

For me, what it means is that the longer I stay on an SSRI or SSNRI, the less serontonin my brain will produce.  It explains why I was OK on 30 mg of Cymbalta for 3 years and then had to go to 60 mg of Cymbalta for the past 2 years.   It also explains why so many people become resistant to SSRIs and SSNRIs
.

 

It was in 1994 that Italian psychiatrist Giovanni Fava, editor of  Psychotherapy and Psychosomatics, urged the field to directly confront this possibility.


In subsequent papers, GIovanni Fava set forth a biological explanation for why this may be so.  Psychiatric drugs perturb neurotransmitter pathways in the brain  and in response to that perturbation, the brain undergoes a series of compensatory adaptations in an effort to maintain normal functioning of those systems. In scientific terms, the brain is trying restore its “homeostatic equilibrium.” Fava has dubbed this compensatory response to a psychiatric drug “oppositional tolerance.”

 

For instance, a selective serontonin reuptake inhibitor (SSRI) blocks the normal reuptake of serotonin from the synaptic cleft, which is the tiny gap between neurons. Serotonin now stays in the cleft longer than normal, and feedback mechanisms immediately kick into gear. The presynaptic neurons begin putting out less serotonin than usual, while the postsynaptic neurons—the neurons receiving the message—decrease the density of their receptors for serotonin. The drug is acting as an accelerator of serotonergic activity; the brain responds by putting down the brake.


Edited by Sayonara2013, 31 January 2014 - 06:17 PM.

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#16 shelbylynne710

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Posted 07 February 2014 - 03:58 AM

Well, hit  bottom again and called the Dr. to tell him we need to start something VERY aggressive as I was again feeling suicidal and felt that I would NEVER get out of this black hole - thinking about just asking him to send me to an institution....I just don't want to be here in this life. It is hell. Has been - 4 ever.  It's no way to live. (But you all understand that).

 

....you know, as a side note -  doesn't it just break your heart when you read these posts --- there are SO SO very many of us that suffer - suffer every single day of our lives?  

 

Two months ago, he put me on a new regimen - Wellbutrin & Vybriid. I've been taking anti-histamines night and day to counter the hives from the Wellbutrin and I have no idea if the Vybriid is working because I made 'that' mistake of starting two new meds together. But I was desperate for relief.  Anyhow - obviously THEY are NOT working.  I tell you, and as I shared with my MD today, the ONLY med that keeps me alive is Vyvanse. Vyvanse actually make me act semi-normal. (The challenge is getting out of bed to take it). But an hour after, I am zipping around like a semi-normal human being. 

 

OK - so today he gave me Fetzima (the sample packs). If you're like me, you want to take the whole package with 8 pills because you are so desperate to feel normal (but I didn't do that).  He also gave me a prescription for Latuda (which he said is Plan B).  He said he doesn't have enough experience/feedback with it yet - so he wants to try the Fetzima first.  So, here I am, writing this at 4 am.  Is it the Fetzime, or is it the Vyvanse?

 

Anyhow - will keep you all posted.  If this stuff doesn't work, I'm applying for disability or going to an institution. I can't function. Lost my home to SuperStorm Sandy, lost my job 3 weeks later, diagnosed with cancer 4 weeks later, and now unemployment has been cut off. AND I am a treatment resistant depressive even under the best of circumstances.

 

 

Hugs to all

 

 



#17 Sayonara2013

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Posted 07 February 2014 - 09:26 AM

Well, hit  bottom again and called the Dr. to tell him we need to start something VERY aggressive as I was again feeling suicidal and felt that I would NEVER get out of this black hole - thinking about just asking him to send me to an institution....I just don't want to be here in this life. It is hell. Has been - 4 ever.  It's no way to live. (But you all understand that).

 

....you know, as a side note -  doesn't it just break your heart when you read these posts --- there are SO SO very many of us that suffer - suffer every single day of our lives?  

 

Two months ago, he put me on a new regimen - Wellbutrin & Vybriid. I've been taking anti-histamines night and day to counter the hives from the Wellbutrin and I have no idea if the Vybriid is working because I made 'that' mistake of starting two new meds together. But I was desperate for relief.  Anyhow - obviously THEY are NOT working.  I tell you, and as I shared with my MD today, the ONLY med that keeps me alive is Vyvanse. Vyvanse actually make me act semi-normal. (The challenge is getting out of bed to take it). But an hour after, I am zipping around like a semi-normal human being. 

 

OK - so today he gave me Fetzima (the sample packs). If you're like me, you want to take the whole package with 8 pills because you are so desperate to feel normal (but I didn't do that).  He also gave me a prescription for Latuda (which he said is Plan B).  He said he doesn't have enough experience/feedback with it yet - so he wants to try the Fetzima first.  So, here I am, writing this at 4 am.  Is it the Fetzime, or is it the Vyvanse?

 

Anyhow - will keep you all posted.  If this stuff doesn't work, I'm applying for disability or going to an institution. I can't function. Lost my home to SuperStorm Sandy, lost my job 3 weeks later, diagnosed with cancer 4 weeks later, and now unemployment has been cut off. AND I am a treatment resistant depressive even under the best of circumstances.

 

 

Hugs to all

 

 

Fetzima will make you hyper and the combination with Vyvanse will keep you awake for hours.  I take Vyvanse as well and could not take it during the time I tried Fetzima.  I felt like a crazy squirrel, running from tree to tree.

Stopped the Fetzima and went back to Cymbalta.  I really don't understand how Fetzima passed FDA trials and it does seem to make people feel more aggressive.... my post is just before yours.



#18 rzstanley

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Posted 11 February 2014 - 10:42 PM

Why can't you people just chill and enjoy the effects of the medication? It can take up to months for these kinds of meds to even start working. They're not street drugs. I just started on the 80 mg. of Fetzima- I was on 40 mg. for two weeks. And, yeah, I felt some of these side effects you guys are talking about. But I feel fine now. Sometimes you just gotta stick things out to get the benefits. Also, you gotta ask yourself, do I feel better on these meds or did I feel better before the meds (dealing with reality). If it's even a tiny bit better then the meds have done their job. You have to remember why you went to doctor asking for meds in the first place. They're not gonna bring you back in time and let you feel like you did when you were a child- they work with what you have now. For me, it's a no brainer. Once I get on meds I start to feel good again and I can actually get things done- not without struggles, of course, but the struggles are minute compared to the struggles I experience off meds. It's just uncomparable. I'm an artist, so, I know that as soon as my art comes back I'm doing something right. I just follow the art. I mean, you have to work at it, too. These meds effect chemicals that literally "are" your brain. So you have to exercise, keep busy, keep your mind working. The point is, if you're having trouble even getting to the place where you can start to do these things- like exercise, working, meeting people, etc.- then these meds are your best bet. And pretty much the only choice of meds you have. I've seen alot of things in my life and I know this for sure: It's short and once things are gone they don't usually come back. We all have to deal with that. So do whatever you can to make yourself feel better and live your life.

I was also having trouble getting to sleep with the Fetzima, so the doctor prescribed Rozerem. So we'll see how that works. My whole problem is getting to sleep, just that initial kickover. I hardly ever get REM sleep- that's usually what I work for..

Edited by rzstanley, 11 February 2014 - 10:43 PM.

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#19 shelbylynne710

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Posted 11 February 2014 - 11:07 PM

Hi rzstanley - thanks for your post.  So, would you say the Fetzima is helping, and if so, when did it start and what were you on before? My MD wants me to ramp up to 80 mg pretty quickly as well. 



#20 Sayonara2013

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Posted 12 February 2014 - 12:00 AM

Why can't you people just chill and enjoy the effects of the medication? It can take up to months for these kinds of meds to even start working. They're not street drugs. I just started on the 80 mg. of Fetzima- I was on 40 mg. for two weeks. And, yeah, I felt some of these side effects you guys are talking about. But I feel fine now. Sometimes you just gotta stick things out to get the benefits. Also, you gotta ask yourself, do I feel better on these meds or did I feel better before the meds (dealing with reality). If it's even a tiny bit better then the meds have done their job. You have to remember why you went to doctor asking for meds in the first place. They're not gonna bring you back in time and let you feel like you did when you were a child- they work with what you have now. For me, it's a no brainer. Once I get on meds I start to feel good again and I can actually get things done- not without struggles, of course, but the struggles are minute compared to the struggles I experience off meds. It's just uncomparable. I'm an artist, so, I know that as soon as my art comes back I'm doing something right. I just follow the art. I mean, you have to work at it, too. These meds effect chemicals that literally "are" your brain. So you have to exercise, keep busy, keep your mind working. The point is, if you're having trouble even getting to the place where you can start to do these things- like exercise, working, meeting people, etc.- then these meds are your best bet. And pretty much the only choice of meds you have. I've seen alot of things in my life and I know this for sure: It's short and once things are gone they don't usually come back. We all have to deal with that. So do whatever you can to make yourself feel better and live your life.

I was also having trouble getting to sleep with the Fetzima, so the doctor prescribed Rozerem. So we'll see how that works. My whole problem is getting to sleep, just that initial kickover. I hardly ever get REM sleep- that's usually what I work for..

 


Dear rzstanley,

If YOU feel good, that's great for you.  Your  successful experience is as valid as the experience of not having Fetzima work.   Report on how it helped you and why you feel better.

Fetzima's chemistry speaks for itself:  Fetzima works by lowering  serontonin and increasing norepinephrine levels in the brain.

If a person cannot tolerate the increased levels of norepinephrine, then Fetzima is not the drug is not for them.  Each person's experience is personal  - by reporting on experiences, others can have the support or reassurance about their own experiences.  The information can be used to help with a decision to continue with the adjustment period or to stop taking the drug.

 

Please don't scold  & attack others because your opinion and results are different - or assume that the only side effects were physical.  Read the literature  - patients are advised to report mood changes to their Doctor.   Mood changes, racing heart & high blood pressure, an increase in anxiety and extreme irritability were all reported.

For me personally - I could not tolerate the anxiety & paranoia that I never had before Fetzima.  I did not like the manic feeling of being grandiose and aggressive and isolated myself so that I wouldn't bite people's heads off or tell people off.  I don't want to take an anti-depressant to feel worse or isolate myself from others because I'm afraid that I'll do something that I regret.

I did think of others when I wrote:

"I think "2C" sums up why some of us didn't feel well while trying to use Fetzima.  I truly hope it  helps some of you"  

"I feel like "me" again, and it was immediately after I stopped Fetzima. The first day was like turning on a light switch.  I've been on Cymbalta for 2 days and there is no more anxiety, frustration or hypomania (racing thoughts, snapping at people, etc)

I'm sorry if I sound like a robot or computer, but I've learned that I have to understand what my medications are intended to help.  If you're like me, you started taking your meds to feel better and if it worked, you were happy. When I start to feel crappy, I want to know what happened.  I hope this helps anybody who tried Fetzima and didn't like the feeling of being on the brink of losing your temper and patience during every moment that you were awake
."


 Please note that adverse symptoms of increased norepinephrine include:
1.  Along with epinephrine, norepinephrine also underlies the fight-or-flight response, directly increasing heart rate, triggering the release of glucose from energy  stores, and increasing blood flow to skeletal muscle.

2.  Serotonin cannot cross the blood-brain barrier. Therefore serotonin that is used inside the brain must be produced within it.

3.  Serotonin's effects on a range of functions tend to be inhibitory. In other words, it reduces appetite, sexual behavior, and suppresses pain perception.

4.  According to researchers at the absence of serotonin has been associated with greater aggressive behavior. They say that serotonin levels have been correlated with higher levels of irritability, impulsivity, aggression, disordered eating, and sleeping problems.

Also, for those who are taking Vyvanse or Adderall in addition to Fetzima, please remember that it is an amphetamine.  Monitor how you feel  and contact your Doctor if your heart rate does not get back to a normal level.
 



#21 rzstanley

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Posted 12 February 2014 - 04:49 AM

Yeah honestly I'm not sure I like the whole lowering of Serontonin thing with Fetzima- it's the whole reason for all complaints about not being able to sleep. Me included. It's like- why can't the people who make this stuff just combine the effects of SSRI's with SNRI's? Is there some reason why they can't do that? It's like you always have to choose- energy or sleep. And it shouldn't be that way. It's really annoying I hope the people that make this stuff figure it out. Honestly, I've had a lot better luck with SSRI's. Like Zoloft. It just feels better taking something that deals only with Serontonin- I can maintain my own energy and there's no irritability. I've found that with Fetzima I'm almost wanting to combine it with another medication- just to get to sleep. Because I have no problems sleeping with SSRI's at all. And I feel there should be a drug that does both energy and sleep. The thing is, I don't think there is. You have to just decide when you wanna stay awake and when you wanna sleep, and take meds according to that schedule. There is no perfect med you can take. But you can find a balance- and if you have to add a med then that's what you should do. For example, I pretty much went all week without sleep last week because of the Fetzima and felt all the side-effects mentioned in this thread. So over the weekend I decided- screw this- I'm tired of not sleeping. So I took a Remeron and it pretty much balanced everything right out. It got that Serontonin working- and that's what was missing!! Remeron is prescribed for insomnia- and probably the best sleep aid I've ever taken. But I don't recommend taking it on a daily basis unless you wanna feel tired and weird all the time. I only use it when I absolutely can't stand it anymore.

 

I'm not "scolding or attacking" anyone. I know everyone is different and reacts differently to meds because their brain chemistry is different. I was just saying be thankful that we live in a modernized society were things like SSRIs and SNRIs are possible. If only to achieve a small about of relief, they are better than nothing. My main point is that you should try different things and/or combinations of meds and find what works best for you.

 

I, for one, like SSRIs. Fetzima just feels too "default" for me. It's almost like I'm not taking anything at all. At least Zoloft puts you to sleep and gives you an appetite. I'm pretty sure Fetzima is supposed to do that to? But I'm not seeing much result there. All I know is that I had to take a different med to get the full advantages of Fetzima.


Edited by rzstanley, 12 February 2014 - 04:58 AM.


#22 rzstanley

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Posted 12 February 2014 - 05:05 AM

I just wanted to add that I started taking Fetzima because my doctor said it was very similar to Cymbalta. And the weeks that I took Cymbalta I really liked how it made me feel. However, Cymbalta caused an adverse skin reaction in me and the itching was almost unbearably painful for 2 nights in a row. So I will never take Cymbalta again, despite how I good I felt on it..



#23 rzstanley

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Posted 12 February 2014 - 05:38 AM

The thing about the SNRIs is they only work on getting you going and then they don't know how to stop. Same can be said about the SSRIs, just the opposite effect. I never feel like either one does its job to its full potential. It take tons of either kind to even have a moderate effect.. But it can sometimes be worth it. (Especially if you need to get something done and you feel like you're too worn out or depressed to do it) So they can definitely be helpful in situations. Just not ALL THE TIME.


Edited by rzstanley, 12 February 2014 - 05:40 AM.


#24 Velthir

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Posted 12 February 2014 - 08:40 PM

You might find you get on better with one of the tricyclic antidepressants like imipramine if you want some norepinephrine effect but with more serotonin action and a little night time sedation. Or something like clomipramine which has a 1:1 serotonin:norpinephrine ratio, along with a little antihistamine action.

 

From a personal point of view I'm actually interested in Fetzima since I don't tolerate real serotonin action but I'm not sure if a tiny bit would be beneficial.


Edited by Velthir, 12 February 2014 - 08:49 PM.

Dx: Bipolar II/III (antidepressant induced mixed states/hypomania)
Rx: 400mg lamotrigine (Lamictal), 800 mg/day of carbamazepine (Tegretol XR), 600 mg/day Zyban (bupropion/Wellbutrin SR)
Failed meds: Cymbalta, citalopram (Celexa), agomelatine (Valdoxan), lofepramine, mirtazapine (Remeron), sertraline (Zoloft), aripiprazole (Abilify), quetiapine (Seroquel), trimipramine (Surmontil)
Partial-success: nortriptyline/Pamelor, moclobemide (Aurorix/Manerix), reboxetine
 
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#25 Sayonara2013

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Posted 12 February 2014 - 10:28 PM

Velthir...

 

I started with this article about Fetzima:  http://www.pharmathe...-for-depression . The author stated 2 things that caught my eye and I talked to my Doctor about oppositional tolerance.

 

 "Fetzima is essentially an isomer, or put more simply, a clone of the SNRI Savella, which is approved for the treatment of fibromyalgia. The interesting thing is that Fetzima is not approved for fibromyalgia and Savella is not approved for depression. Go figure. Round up the usual suspects when it comes to the side effects of Fetzima – nausea, heart rate increase, palpitations, erectile dysfunction and other associated SNRI side effects."

"What we don’t need is yet another SNRI poised to fuel oppositional tolerance, which places the brain in a fighting position to counter the effects of artificial serotonin and norepinephrine manipulation rendered by these antidepressants."

 

As for the levels of serotonin and norepinephrine, there are many sources - but sometimes you have to wade thru some pharmacology & biochemistry - or articles about oppostional tolerance (which is why I asked my Doctor). 

 

Hope this helps you.  Good luck.

 

 

 

http://www.socialanx...fetzima-835513/

 

Quote:
*UPDATE* The drug is making me sweat more than usual & seems to have increased my anxiety. Could be because it deals with norepinephrine more than serotonin? =\
Yes. Levomilnacipran (fetzima) has a 1:2 relationship between preferring serotonin and norepinephrine, respectively.

 

 

http://www.dryeyezon...p?19829-Fetzima - this one was the easiest for me to absorb.  What's interesting is that Savella & Fetzima are "clones" of each other - but look at the ratios.

 

 

There's a new antidepressant coming out later this year - called Fetzima (levomilnacipran).
Fetzima is a chemical cousin of Savella (Milnacipran)
Fetzima is only approved for treatment of Major Depression.

Link to Fetzima:
https://fetzima.com

Savella is only approved for treatment of fibromyalgia.
http://www.savella.com

Not sure how much better Fetzima will be over other SNRIs like Cymbalta

here's the specs about it in comparison to other SNRIs (and, see attached paper)
Venlafaxine - has a 30-fold greater specificity for serotonin than norepinephrine
Cymbalta - has a 10 fold greater specificity for serotonin than norepinephrine

Milnacipran(Savella) - has a 1:1 relationship regarding serotonin and norepinephrine (prefers each the same ratio)
Levomilnacipran (fetzima) has a 1:2 relationship between preferring serotonin and norepinephrine, respectively


Link to abstract about Fetzima
http://www.ncbi.nlm.nih.gov/pubmed/23499664


 

This is from the link above.


.
Levomilnacipran (LVM; F2695) is the more active enantiomer of the serotonin/norepinephrine (5-HT/NE) reuptake inhibitor (SNRI) milnacipran 

  • LVM had 2-fold greater potency for norepinephrine relative to serotonin reuptake inhibition (i.e. NE/5-HT potency ratio: 0.6) and 17 and 27 times higher selectivity for NE reuptake inhibition compared with venlafaxine and duloxetine, respectively.
     
  • In summary, LVM is a potent, selective inhibitor of NE and 5-HT transporters with preferential activity at the former.

 

 

 

 

 

 


 


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#26 rzstanley

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Posted 12 February 2014 - 10:42 PM

Velthir, thanks for the advice. I might just go with nothing for awhile. cause I don't see how it's much different from feeling like this. Just *null all the time



#27 Velthir

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Posted 13 February 2014 - 07:42 AM

Velthir...

 

I started with this article about Fetzima:  http://www.pharmathe...-for-depression . The author stated 2 things that caught my eye and I talked to my Doctor about oppositional tolerance.


 

 

Yeah, I was cross-referencing and realised I was remembering/reading the stats for regular old milnacipran. My bad. Edited my original statement out of my post when I saw more stuff saying that it was 1:3 or 1:2 for Fetzima (although I did still find another thing that said 1:1 for Fetzima.. Gotta love conflicting info.

 

I am somewhat surprised that Fetzima did well enough in trials to pass, it does seem that the majority of people do better with more serotonin action. There are some people who do well with purely norepinephrine/strongly norepinephrine biased meds, but not as many (anyone with pre-existing anxiety might have issues, for example). I personally can't deal with serotonin (to the point where 90 mg of Cymbalta gave me borderline serotonin syndrome) and can't get enough dopamine/norepinephrine action.

 

I have to wonder if they fudged the numbers or very carefully picked their test subjects.


Edited by Velthir, 13 February 2014 - 07:55 AM.

Dx: Bipolar II/III (antidepressant induced mixed states/hypomania)
Rx: 400mg lamotrigine (Lamictal), 800 mg/day of carbamazepine (Tegretol XR), 600 mg/day Zyban (bupropion/Wellbutrin SR)
Failed meds: Cymbalta, citalopram (Celexa), agomelatine (Valdoxan), lofepramine, mirtazapine (Remeron), sertraline (Zoloft), aripiprazole (Abilify), quetiapine (Seroquel), trimipramine (Surmontil)
Partial-success: nortriptyline/Pamelor, moclobemide (Aurorix/Manerix), reboxetine
 
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#28 ebmosier

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Posted 15 February 2014 - 11:46 AM

Something else I've noticed more lately - I'm having a lot of trouble sleeping. Most nights I'm fine; if I'm tired, I'll fall right asleep. It's usually just getting up that's an issue. I'll wake up usually about two hours before I have/want to, so some mornings if I have to get up at 8:30, I'll wake up at 6:30. Going back to sleep usually isn't a problem, but it was this morning, for some reason. If I do manage to get back to sleep, it's not for very long. Naps are the same way.

 

I also feel a little more irritable, but that could be hypochondria. I'm seeing my doc again on Monday, so I'll update then.



#29 Sayonara2013

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Posted 15 February 2014 - 12:08 PM

Velthir - I'm very sure that the combination of Fetzima (evening dose) and Vyvanse for dopamine (morning dose) was the cause of my Serontonin symptom, I became hypomanic and I'm not a bipolar 1.  I mostly have anxiety and am a borderline bipolar 2, because when I'm depressed it's a very deep depression. 

 

I isolated myself because I couldn't stop the racing thoughts and I couldn't control my blurting - if it came into my head, I said it out loud and sometimes it was irritable and mean.  The irritability increased each day as I took Fetzima - to the point where I even stopped I taking Vyvanse. I couldn't fall asleep, no matter what I did and lack of sleep was making everything worse.

 

I was already weaned off Cymbalta and I'm sure that the irritabiltiy was due to Fetzima and increased norepinephrine levels.

Fetzima is everywhere - the Forest Pharma reps are dropping off large boxes of samples.  I have about 12 weeks of samples to return to my Doctor.  Fetzima is not on the formulary for my insurance, so I would have needed a pre-authorization.

Meds don't work the same way for everybody.  If Fetzima is working for you, then stick with it.  If  Fetzima is not working and you spend every waking hour, just trying to manage it - then talk to your Doctor.  I  went back to the Cymbalta and Vyvanse combination - and feel fine again.


Edited by Sayonara2013, 15 February 2014 - 12:09 PM.


#30 erinserb

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Posted 26 February 2014 - 03:36 PM

I just started here on the depression forum today :-)  - I was given sample of Fetzima by my doc today, and will start it tomorrow.  I am on Cymbalta, Anafranil and Lamictal, with baby doses of Ativan when getting nervous energy.  Doc told me to back off to one Cymbalta cap (30mg - as opposed to 60mg).  I have been on a great number of AD's over the years, but I always seem to come back to Cymbalta and Anafranil.  I am just not satisfied and it has been a long road, but my doc has helped me quite a bit over the years.

 

I have lots of brain fog which is both frightening and frustrating.  I believe my doctor and I agree that i have some type of depersonalization/deprealization element in my depression.  I am many years removed from major depression, and it is now kind of a low-level to moderate depression.  Anfranil was given for the obsessive thoughts that I've had over the years, particularly thoughts that question my reality and the world around me, hence the dp/dr diagnosis.

 

I hope and pray everyone here finds some peace and healing; it is just a day-by-day thing, but I do believe things will get better.  I was on full disability for nearly 7 years, went back to school, and back at work since 2009.

 

I will let you all know how the Fetzima goes, I am praying and keeping my fingers crossed.



#31 michelletress

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Posted 06 March 2014 - 12:55 AM

Fetzima day 12. Doing much better after initial first few days. I am very shaky. But no depression all day!

#32 erinserb

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Posted 06 March 2014 - 03:27 PM

michelletress - I made it to day #8 - same results as you - doing slightly better and noticiing an improvement - was a little shaky, but doc. lowered my cymbalta to 30mg. - best of luck to you! :-)



#33 The Sage Nabooru

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Posted 10 March 2014 - 07:16 AM

I'm on day 4. I was on 20mg for two days, now I'm on day two of 40. Lately I've been feeling so, so terrible.....how long does it take to kick in?

#34 michelletress

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Posted 12 March 2014 - 04:30 PM

Day 18..  The shakes are terrible.  I hate them.  Do they go away.  My heart is racing.  But I will admit I have no depression and most anxiety is gone.  The Sage it did take 12 days to really know it was working.  I am not really irritable.  The heart thing drives me nutts.  I do also have nausea.  And some nights I really struggle to sleep.   But I will admit all of that is worth the no depression.



#35 The Sage Nabooru

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Posted 12 March 2014 - 08:38 PM

I don't have any shaking. The only physical symptom I have is chest heaviness, but that's not from the medication, it's from my anxiety and depression. That's why I asked a couple days ago when it kicks in since I really hate that chest pain. I don't know if I causes the depression or if the depression causes it. They definitely seem to fees off each other.

#36 rzstanley

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Posted 13 March 2014 - 10:28 PM

I hate this med. I'm getting back on an SSRI



#37 rzstanley

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Posted 13 March 2014 - 10:29 PM

I feel horrible. I'd rather just be depressed. I'm having more suicidal thoughts on fetzima anyway.



#38 fml232

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Posted 20 March 2014 - 10:44 PM

I am about to start Fetzima and am extremely worried. I feel back into depression while still on wellbutrin 150xl and zoloft 50. After previously having increased to 300 on wellbutrin with terrible side effects (brain fuzz and shocks), my pdoc had me increase to 75mg and then 100 mg on zoloft. I was completely incapacitated. No energy, focus, or ability to even talk. Now he's taking me off the zoloft and replacing it with Fetzima. My issue is, years ago I was prescribed pristiq and effexsor. Both were ineffectual and gave me severe side effects (out of it, dizziness, headache, and more I can't remember). Since this is also an SNRI, should I be concerned? Also, taking it alongside wellbutrin, was that a problem for anyone?

Sorry for the rambled response.



#39 The Sage Nabooru

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Posted 21 March 2014 - 07:57 PM

I got taken off Effexor and pristiq and put on fetzima. I think I need a higher dosage, since I still have bad days, but it's much better than Effexor. I don't have nearly as many side effects on it.

#40 fml232

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Posted 22 March 2014 - 05:53 PM

Thanks Sage! Just started on day 1 with 20mg in addition to 150 wellbutrin xl. I'll keep you posted






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