Live free or die... but never depressed....

Regarding anti-depressants...

I said in my earlier message that there are basically two different kinds and which category works for you will be dependent on your genetic makeup. The best way to determine which drug works best for you is to experiment at the direction of your psychiatrist or in drug-resistant, long-term problems, a consultation with a psychopharmacologist may be in order. There are the different types including (NRI, SNRI, SSRI, Tricyclic) and method of inhibition (PgP or non-PgP):

P-glycoprotein substrates Inhibitors (PgpI) ie Celexa, Lexapro, Paxil, Zoloft (all are SSRIs) and then Elavil (which is a tricyclic) and Effexor (which is an SNRI)

NON P-glycoprotein substrates (non-Pgp) ie Prozac, Fontex, (SSRI) Remeron (Tricyclic)

Obviously this list is far from complete but I will continue to compile information. I have spent the last hour trying to categorize the method of inhibition for Cymbalta but was unsuccessful in my attempts. I will consult with some of my sources and repost when I have more details. However, in my research regarding Cymbalta, while it addresses neurological pain through inhibiting the reuptake of norepinephrine, when compared head to head with Celexa, Cymbalta's efficacy is significantly less while its potential serious side effects such as hypertension, renal failure and hepatic failure in addition to an increase in anxiety compared to that of Celexa leaves no logical rational for prescribing Cymbalta over Celexa or Celexa in combination with Wellbutrin. Before taking Cymbalta, please do your homework very carefully. It is being widely prescribed right now because it is being heavily marketed and doctors from family practitioners, rheumatoid specialists, endocrinologists as well as psychiatrists are dispensing samples and writing prescriptions for Cymbalta. Conversely, in a study conducted in 2009 the tricyclic anti-depressant Remeron was shown to have an efficacy rate equal to or higher than that of NRI, SSRI or SNRIs with much less side effects. Newer does not always mean better.
It is important to understand that a well trained psychiatrist usually sticks to between 15 and 20 drugs that he/she prescribes regularly even though there are many more choices available on the market. This practice is done for your safety. As new drugs are introduced, a prudent physician will hold off on prescribing the latest, greatest thing from the drug representative and doling out samples while that doctor does their own unbiased journal research on efficacy, drug-drug interaction, methods by which the drug works and how the drug effects the organism as a whole.
The best thing each one of us can do is become a partner in our own medical care. Make sure we use the same pharmacy for ALL prescriptions regardless of which doctor wrote them, if you are continuing to experience adverse symptoms talk to your pharmacist about which drug or drugs may be involved and what alternatives they may recommend, research your medications from at least 5 neutral sources and do the same with proposed medications. Finally, do not hesitate to speak up, make suggestions, ask questions and if your issue continues, you can continue to repeat your request for help (go on, be a broken record... it works!!!) with that particular problem while you seek a specialist in that area if at all possible. Remember though, when you are accessing your medical team, don't forget that pharmacists have had the same number of years of training as physicians but all they studied were medications. Don't hesitate to use them as a resource.

ptk