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Withdrawal Side Effects Even Before I Start Tapering Off -__-

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#1 mutalune



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Posted 19 July 2023 - 10:24 AM

Hi all - New to the forum, so I apologize if I'm posting in the wrong area about this. I'll give the backstory (which is long and can probably be mostly skipped, I'm just trying to include as much detail as possible upfront), current situation, and my "please help me Obi-Wan Kenobi, you're my only hope" plea for assistance.


Backstory: I've had mental health issues for pretty much my entire life and have been seeing a therapist since 2017. I have PMDD (pretty much extreme PMS where my depression/anxiety symptoms get SIGNIFICANTLY worse during my luteal phase) which I was managing for awhile using hormonal birth control, while therapy was helping with the day-to-day depression/anxiety/etc. enough that I was at least functional and managing life, ya know?


Welp, I got super lucky (/s) and got 3 pulmonary embolisms from said hormonal birth control in 2020 right before covid blew everything up, and I can no longer be on anything hormonal like that since I'm at an increased risk for future blood clots now that it's happened once before. Cool, fine, whatever - my gynecologist gets me started on Zoloft, we get up to 50mg (alternating doses and such with my cycle, trying a consistent dose, etc. This is normal with PMDD because some people get relief if they just take meds for their luteal phase, but that's never helped me at least) before she refers me to a psychiatrist, and that psychiatrist gets me maxed out on Zoloft before adding Wellbutrin to the mix. None of this makes a dent on my PMDD and mostly just makes me incapable of staying awake while steadily getting more depressed. Psychiatrist tapers me off of Zoloft and starts me on Effexor. I'm on Effexor for about 3 weeks, I go, "This is making me lower than I've ever been, I want to stop," and she goes, "Tough it out for another month to let it take full effect." I do, I get even lower depression-wise and have my first brush with Scary UnAlive Thoughts, and message her to be like, "We gotta get me off of this now because I'm scaring myself." She tries again to push me to stay on it, so I more or less tell her to go f herself and stop cold turkey.


I now know that cold turkey for SNRIs is NOT the way to go. It sucked, I pretty much had what felt like a 2 month long flu, but I got through it and it wasn't as terrible as it could've been (esp after reading people's reactions on here when they go off, woof..).


I see a new psychiatrist who is a lot less awful, and she starts me on Prozac. Prozac took the, "You can't be anxious if you don't have emotions," approach, which isn't super great for depression and I once again get low to the point where I'm like, "Yeah I don't actually want to be dead but this is convincing me I do, we should stop." So we taper off of that, and I try being med-free for a bit in late 2022. After all, I've done a lot of work in therapy! I have a lot of coping skills! Maybe I don't need meds since all of the ones I've tried have just made me worse. And for the most part, I'm alright. Some highs and lows, my PMDD is pretty rough, but I'm functioning and generally WANT to be living my life which is a win for me. Until...


Welp, January 2023 happens. Some personal stuff triggers me pretty badly and I go off the deep end. I still don't really know what it was, either a week-long panic attack or some kind of nervous breakdown or meltdown or what, but I'm talking pacing in my apartment feeling like the world is ending and I'm the worst human being who has ever existed or ever will, nothing matters nor will anything matter ever again, and if I have to feel this way for one more moment I'm going to do something idk what but SOMETHING - And this results in me calling my mom to come stay with me as I call my therapist and psychiatrist and discuss if I should be hospitalized. We all agree that nah, I'm not at that point - Psychiatrist gives me a temporary prescription for Klonopin to take as needed for a few weeks while we get me back on Zoloft and let that kick in, and I stay with my parents for a week until I feel stable again.


Cool. Except I went off of Zoloft for a reason, which is: It makes my depression worse. So like yes I'm stable on the anxiety front and not having an entire life-ending crises like I was in January, but every day is looking bleaker and bleaker. So we swap me off of Zoloft and try Cymbalta starting in May, starting at a 20mg dose.


Current situation: From the start, I got the feeling Cymbalta wasn't for me. I'd wake up hours before my alarm, super nauseous/cramping (the kinda cramping where it feels like you have to poop but there's nothing in the tank), and because of the nausea/cramping THAT triggers my anxiety and I'm feeling supremely awful for the first 1-2hrs I'm awake. Then I take my meds once I'm sure I can keep it down and about an hour after that I feel alright-ish. I'll feel like a zombie for the workday, the workday ends and I have dinner, then all of the anxiety that was being suppressed all day comes back in full force. Tell my psychiatrist this, and her solution is having me take 20mg in the morning and an additional 20mg at night (so 40mg altogether, I'd try to space them out 12hrs apart). Which I guess kind of helps? I still wake up nauseous and with cramping, I still feel like a zombie whenever I'm not actively anxious, and the only way I could keep dinner down most nights if if I was smoking marijuana. I went from a casual "sometimes this helps my insomnia, sometimes I prefer this to drinking," kind of pot user and became a daily stoner in the course of 3 months just to manage these side effects.


For awhile I was so freaked out by what happened in January, just how bad that kind of breakdown was and how close I came to needing to be hospitalized, that I was like, "Okay, the side effects suck, but I'm stable. I'm stable, right? So maybe I should suck it up?" But realistically, if I'm requiring an eighth of pot to get through a week and I've lost 20lbs since starting Cymbalta while being less active than ever since I feel like a zombie and don't want to do anything, just because I'm alternating between being so nauseous I can't keep food down and being anxious that if I eat something it'll trigger that nausea-anxiety combo.... Yeah, this probably isn't worth it.


What REALLY made me realize this isn't sustainable was that I've had 3 times since taking Cymbalta where I've had to use the remaining Klonopin that I have from my January breakdown - and I recently put together that all of those times were when I forgot to take my nighttime Cymbalta at my usual time. I'd start feeling awful around 8PM (I normally take it at 7AM and 7PM), get worked up to a total frenzy of "oh god everything is terrible I feel terrible it's all terrible how can i possibly tolerate this even five minutes longer," take a Klonopin and go to bed, wake up MORE nauseous and crampy and with that same horrible-Everything is Terrible Feeling, take Cymbalta, and 1-2hrs later be back to the zombie-like but at least functional state that's become the norm.


Help Me Obi-Wan Kenobi: I am so so SO afraid of going off of Cymbalta even though I know I have to. If missing one dose by an hour is enough to send me spiraling THAT badly, I don't know what it's going to look like to start tapering off. And I'm pretty sure the reason I feel nauseous/crampy every morning and evening before I take my next dose is because I'm microdosing withdrawal symptoms... I seriously don't know if I can handle it if the withdrawal will be as long as I've been taking Cymbalta, but I also can't keep taking it when it's making me so sick. I'm miserable physically, socially (hard to go out with friends when you feel so horrible physically and also feel like a zombie and don't give a single crap about anything at all), and mentally (RE: zombie when the meds work + the worst anxiety I've ever had in my life when they don't).


I sent my psychiatrist a message yesterday pretty much explaining all of this + the other side effects/concerns I've had with it, and I have an appointment with her tomorrow morning. I guess I'm mostly just asking if there's anything I can do preemptively before we start tapering off that might be able to help, or any tips/tricks/help regarding the World Ending Worse Anxiety of Existence feeling that I know I'm going to be struggling with.


I tried reading the ebook that you guys have here (which is an AWESOME resource, thank you for putting that together and making it available to the public. Seriously so comforting to know that other people have been through this, even as crappy as this entire situation is, and even more comforting to know that there's so many options to try to help with withdrawal) but I'm kind of at the "freaked out" level where it's hard for me to take in new information and I feel overwhelmed trying to pick where to start with supplements/etc.


Any help/advice/support would be appreciated. Thank you for reading my extremely lengthy post if you made it this far!

#2 fishinghat


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Posted 20 July 2023 - 08:00 AM

Welcome mutalune


My name isn't obi wan kenobi but I will try and help if I can. lol


I really appreciate the details in your post. It helps put things in perspective. My first thought when reading your background was testosterone failure due to the antidepressants causing the increased depression when starting on an antidepressant. I would also think that your PMDD would make you more susceptible to this. There was a recent study that evaluated 13 antidepressants and there effect on testosterone production. You have been on some of the worst ones (Zoloft, Effexor, Cymbalta). While the association of low testosterone and depression is well known in men as they age the research shows that this also applies to women. If your testosterone levels have been effected it would make you more vulnerable to antidepressant induced depression. I will see what I can find on point in the medical journals later today and maybe into tomorrow.


As far as coming off the Cymbalta, well as you know it is seldom a cake walk. I will post a like to what has been shown to be the best supplements and life changes to minimize the withdrawal. How long have you been on the Cymbalta now?


Hang in there. We will do all we can.

#3 fishinghat


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Posted 20 July 2023 - 08:08 AM

Items Proven to Help Many with Cymbalta Withdrawal.
Diphenhydramine, (over the counter) also known as Benadryl, is an antihistamine and as such is not only used for allergies/colds but also as a sleep aide. It does have a mild anxiolytic effect. May lower blood pressure and cause irregular heartbeats. Your body does build up tolerance to it after a few weeks. This medicine has many drug interactions.
Begins working in 15 to 30 minutes
Peak levels - 2 to 2.5 hrs
Half Life – 4 to 6 hrs
Use by members for anxiety releif and to help sleep is too numerous to mention. 
Diphenhydramine should NOT be taken with hydroxyzine. Drugs.com
serendipity - I found Benadryl to produce hangover effects, and cause palpitations when taken long term. Even if you wake up in the middle of the night, and can't get back to sleep, even a teeny amount (say, 15mg) can induce sleep again. 
Schmb - Benadryl worked on a limited basis for me, because sometimes it makes me jittery, and that only made the zaps much worse, so just use some caution in case you are sensitive to it.
FH - One caution on benadryl. It is famous for bad reactions with other medicine so check your compatability closely. The maximum dosage of benadryl is 25 to 50 mg every 4 to 6 hours and do not surpass 300 mg in a day.
Benadryl Total
Medicinal ingredients:
•Acetaminophen, 500 mg
•Diphenhydramine Hydrochloride, 25 mg
•Pseudoephedrine Hydrochloride, 30 mg
It contains diphenhydramine which is the active ingredient in regular Benadryl and also pseudoephedrine which is common in most cold medicines. The Diphenhydramine helps with sleep and anxiety and the pseudoephedrine helps block the action of adrenaline which produces a calming effect. 
FH - a research article where it was shown that taking 0.7 mg of liquid melatonin under the tongue (sublingual) helps with anxiety. Place it under the tongue until dissolved and gone. In case you are not familiar with melatonin it is the chemical your body produces in the evening to make you sleepy and ready for bed. 
Many members found Gatorade to be considerable help in fighting most withdrawal symptoms, especially the green gatorade.
Kindorf - Also I have been avoiding caffeine so I cut out my coffee and sweet tea.
I replaced then with fruit juice, ( mainly apple juice ) water and Gatorade. Today no stomach cramps I think they are done. No diarrhea, Lord I hope that is gone. 
Judy -  I knew that Gatorade helped with the light-headed, "floating brain" feelings. 
watchdog -  Drinks LOTS of GREEN gatorade..... don't know what the deal is, but it helps.
wiraz - Drink at least one G2 Gatorade a day – stay away from the full sugar version, leads to a higher chance of diarrhea. I drink one 32 oz bottle every day plus tons of water!!
caroline - Vit E also for head and joints and then Gatorade's G2. I didn't want the sugars so I went with the G2
Rafael -  I have mild brain zaps but I believe the omega 3 Fish Oil and Gatorade are helping.
Sandlion - I took fish oil/other Omega 3 and also found that Gatorade helped -- maybe it's the salt replacement after all the nightsweats.
guppie -  I'm a month off the drug so only minor zaps now and then. Whoever gave the gatorade advice is a genius. That treats them instantly (make sure you get the low calorie gatorade since regular is high calorie). Brain zaps are minor. I grab a gatorade and that gets rid of those for a bit (electrolytes). 
Alisha - gatorade-had one of the big bottles yesterday and it did seem to help,
Vinvin - The Fierce Green Apple Gatorade, Dramamine and Boylan's Ginger Ale seem to help out as well 
Summary - Many members mentioned drinking Gatorade for the electrolytes after diarrhea, night sweats and when having brain zaps. G2 was often mentioned because it has no sugar (not true, see below). Also, it was suggested that one should not just rely on Gatorade alone for hydrated but should also drink plenti of water. Green Gatorade is highly recommended by some members.  Vitylite and Powerade were also mentioned a couple times for electrolytes. I would also recommend Isopure as it comes with and without sugars and proteins with a similar amount and type of electrolytes as Gatorade.
G2 Gatorade - It has the same amount of sugar as regular Gatorade and nearly all the same ingredients and electrolytes.
Gatorade Fierce Green Apple Sports Drink - This may be the "green  gatorade" that members spoke of. It contains malic acid, the active ingredient in apple cider vinager which has proved so helpful to other members. Other ingredients are the same.
Isopure Zero Carbs - No sugar, with some calcium. Contains Malic acid
Isopure Mass - With sugar and proteins, with calcium, Contains Malic acid
Isopure zero carb with proteins - no sugar, contains proteins. With calcium  Contains Malic acid
Sparkybird - I’ve found that Pur Aqua Sparkling Frost in any flavor has malic acid. I discovered it by accident. It is only 50 cents at Aldi’s. It is only 10 calories a bottle.
L-theanine is an amino acid precursor to glutamate (involved in the synthesis of GABA) and glutamine. It can cross the blood brain barrier. It is only produced by plants and fungi and a component in some teas. It inhibits glutamine transporters and glutamate transporters, and thus blocks the reuptake of glutamine and glutamate. Theanine increases serotonin, dopamine, GABA, and glycine levels in various areas of the brain. Caution – Most plants that contain L-theanine also contain caffeine and it can be a significant contaminant in L-theanine supplements. It is synthesized from glutamate using the enzyme glutamate decarboxylase and pyridoxal phosphate (which is the active form of vitamin B6) as a cofactor. This process converts glutamate, the principal excitatory neurotransmitter, into the principal inhibitory neurotransmitter (GABA).
Member's comments
(puritan's pride) 200 mg capsules 2- 3/ day. I have been taking this prior to cymbalta detox. It helped me reduce my dosage of clonazepam. Within 20-30 mins I feel more calm. I do believe it is helping keep the anxiety in check.
Tinabee - For now I have started taking fish oil and a supplement called Theanine Serene that is supposed to help with anxiety. I know it sounds silly since I've only taken the anxiety supplement for a couple days but I really feel like it has helped.
200mg L-Theanine in the morning with a full glass of water on an empty stomach, you can take again in late afternoon 100 to 200 mg if needed (make sure it is suntheanine - it helps with headaches and pain as any painkiller I had just did not cut it)
Member's comments were generally favorable.
Page 1 and 2, detailed information on L theanine and its usage.
The research shows that all green tea leaves contain both L-theanine and D- theanine BUT only the special processing used by the manufacturer produces pure L-Theanine and is the choice of many of the research biologists.
Five of the six products contained significant amounts of D-theanine. Only one product, SunTheanine, appeared to contain only the L-theanine enantiomer. D-theanine is not used by the humnn body.  Suntheanine is the pure ingredient and that is what you want. 
Key Points
Theanine increases serotonin, dopamine, GABA, and glycine levels in various areas of the brain. 
Scientific Information
A National Standard monograph that reviews current research on theanine reports that it is likely safe in doses of 200–250 mg up to a maximum daily dose of 1,200 mg. Theanine is used to help with anxiety, blood pressure control, mood, and cognition. 
Nutritional Blood Tests for Causes for Anxiety and/or Depression.
Items proceeded by an asterisk are analysis that are routinely performed by many Psychiatrists. Those proceeded by two astericks are ones that members have found to cause anxiety and/or depression.
Omega 3 and 6
Amino Acids
to include...
to include...
**  *D
*B vitamins (**B-6)
Lipid Profile
Psychiatrists also often perform the following tests
*Thyroid Function
*Liver Function - (FH - The AD manufacturers usually recommend an annual Liver Function Test (LFT) to keep an eye on that issue. 
Parathyroid Function
Pituitary Function
An increasing number of psychiatrists are also opting to do a genetic screening for genetic mutations.
Prescription Meds
Clonidine  (Catapres, Kapvay, Nexiclon, Clophelin) is a classic blood pressure medicine BUT it is very effective on anxiety. It is an alpha adrenergic antagonist which means it stimulates the alpha adrenaline synapses located in the frontal lobes of the brain. When these synapses are stimulated by the clonidine the brain thinks that it is due to adrenaline and it tells the adrenal gland to produce less adrenaline. It is a little slow to kick in, about an hour and a half. It has a 12 hour half life. Most drs prescribe 0.1 mg twice a day. One to be taken about an hour before bedtime and the other in the morning. Because it decreases adrenaline it has a strong calming effect which helps a person get to sleep and stay a sleep. It is not unusual for people to have a little drowsiness from clonidine until they get use to it (1 or 2 weeks). It does NOT work faster sublingual (under the tongue) like benzos.  These have no withdrawal but your blood pressure may spike for a couple weeks if you cold turkey. Due to the lowering of blood pressure and sleepiness it is common for the patient to start with ½ tablet at bedtime. Once the patient adjusts to the medicine they begin a ½ tablet in the morning. As sleepiness and blood pressure stabilize they are slowly worked up to the 2 tablets (0.1 mg each) a day. 
Begins working 60 to 90 minutes
Peak levels – 3 to 5  hrs
Half Life – 12 - 16 hrs
There are too many research articles on clonidine's anxiolytic properties to list here.
FH - I started clonidine but it was a relief to me NOT to be able to feel my heart pound through my chest. As long as your bp is OK you shouldn't have a problem. 
That is why the slow start up. This gives your heart a chance to adapt to the new med. I did the same slow start up and my bp stayed within normal range. Just keep monitoring your bp and you should be OK.
FN - clonidine worked wonders for me 
Hydroxyzine, (Vistaril, Atarax) - is an H(1)R antagonist, is very effective against anxiety in most people but some get no help from it at all. It is not addictive nor does it have withdrawal but it also can lower blood pressure some but that usually goes away with time. This medicine should be started slowly to give your body a chance to adjust to the blood pressure effect. Normal dose is 25 mg four times a day but can go as high as 400mg/day.
Begins working in 30 minutes or less
Peak levels - 2  hrs
Half Life – 15 to 20 hrs
Do not take with cimetidine as it increases hydroxyzine levels in the blood.
(Mayo Clinic)
For oral dosage forms (capsules or suspension): 
To help control anxiety and tension: 
Adults—50 to 100 milligrams (mg) 4 times a day. 
Atenolol is a beta 1 adrenergic receptor antagonist, also known as a beta blocker. It does not pass  through the blood brain barrier which limits its side effects compared to other beta blockers. It has been linked to a higher risk of type 2 diabetes. It may cause drowsiness and lower blood pressure. Typical dosage around 25 mg four times/day. Dosage should be slowly increased.
Begins working in 30 minutes to an hour
Peak levels – 2 – 4 hrs
Half Life – 6 - 8 hrs
SF - So now I am on one. It is called Atilonol (Atenolol?) and calms down your heart rate too.
Buspirone (Buspar) is a seratonin 5-HT1A  receptor partial agonist and a dopamine antagonist at the receptors. It functions as a weak anti-anxiety medication similar to diazepam in strength (a weak benzo). No withdrawal or tolerance issues. Dosage should be kept low if taking a ssri and/or snri or St. John's Wort as it may cause seratonin syndrome. DO NOT take with grapefruit or grapefruit juice. May lower blood pressure. Typical dosage is 10 to 20 mg three times per day.
Begins working 3 to 7 days after begin dosing
Peak levels - 1  hrs
Half Life – 2 - 4 hrs
Buspar (15mg) and Melatonin (3 mg) yielded the best anti-depressant effect of any combination concentration tested. (See Melatonin below)
Buspar and melatonin in combination is anxiolytic.
Dos and Don'ts
DON'T ...
take Omeprazole (Prilosec)
Significant drug interactions.
omeprazole ↔ citalopram
Applies to omeprazole and Celexa (citalopram) 
Talk to your doctor before using citalopram together with omeprazole. Combining these medications may increase the blood levels of citalopram and increase the risk of certain side effects, including an irregular heart rhythm that may be serious or life-threatening. 
Caution - Omeprazole causes the increased absorbtion of nearly 500 medications. It should NOT be taken with.....
Benzos, Atenolol, Celexa, Lexapro and many other ssri and snri, st. john's wort, etc.
take St. John's Wort, 5HTP, tryptophan, SAMe, Dextromethorphan (a cough syrup/cold medicine) with an antidepressant - Serotonin Syndrome.
Don't take Stimulants (Make anxiety worse)
Over-the-counter cold preparations contain phenylpropylamine and pseudoephedrine*
Sleep deprivation
B Vitamins*
Coconut Oil 
* - Only some people have this reaction.
Things containing caffeine..
Coffee, Espresso, Cappuccino, some Teas,  Low calorie, non-cola soda containing aspartame,  Low calorie colas containing aspartame or saccharine, Energy drinks, Some types of alcoholic drinks.
Chocolate ....Baking, Dark, Sweet and semisweet, Pudding, Cereals, Fudge , Milk chocolate, Syrup, Mousse, Soymilk, Fat free cookies, Cookies, Cake, Frozen Yogurt, Ice cream, Frosting, and Shakes .
Java Pops, Chai Mints, Green Tea, Warp Mints, Penguin mints, and cinnamons. Caffeinated Energy Strips, Caffeinated Fruity Lollipops, HyDrive Energy Chews, Caffeinated Nixie Tubes, Foosh Energy Mints, Atomic Energy Bites, Buzz Bites, KickBricks, Energy Chews, Reload Energy Strips, Movit Gummies, Caffeinated jellybeans, Morning Spark, Oatmeal, Sumseeds (caffeinated sunflower seeds), Lightning Rods (beef sticks), Engobi "Energy Go Bites" (crispy snacks), Jolt Gum, Blitz Energy Gum, Think Gum Stay Alert, Vibe Black, Black Go Fast!, Dozens and dozens of herbal supplements.
List of energy drinks with caffiene. (over 100)
take Depressants (Make depression worse)
Oxalic acid is found in members of the spinach family and cabbage, broccoli, brussels sprouts, chives and lamb's quarters are high in oxalates, as are sorrel and parsley. Rhubarb leaves contain about 0.5% oxalic acid.
Can cause depression, lack of minerals, kidney stones, and more. Cooking does not affect oxalic acid. People with kidney disease, a history of kidney stones or suffer from depression should avoid these foods. 
other depressants:
High Fat Dairy
Trans fats
Pesticide residue on foods
exposure to organic solvents (paint, varnish, stains, cleaning solvents, paint thinner, etc).
take 500 mg of vitamin C per day or 300 mg of NAC - (N-acety cysteine) an antioxidant
learn Cognative Behavioral Therapy or Mindfulness
sleep as much as possible
Keeping a Journal  - Don't trust your memory durinmg withdrawal.
Stay hydrated

#4 fishinghat


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Posted 20 July 2023 - 08:11 AM

Omega 3
Dose - Omega 3 is recommended at 2000 mg/day EPA and DHA for anxiety, give or take a couple hundred depending on what research you read. It has been shown that only the EPA and DHA components effect anxiety. Any other omega 3 fatty acids don't do anything for anxiety. Life Extensions, Mega EPA/DHA, is distilled (molecularly purified) so you don't get any impurities with your product plus it contains no mercury. Some even provide a certificate of analysis if requested. They also have ones that are enteric coated now that will not irritate the digestive track and has no fish burbs to them. 
This thread contains a detailed discussion on use of Omega 3.
Also this thread....
Fishinghat - Omega 3 fish oils can be very high in mercury depending on the type of fish used. Some have tested at over 300 ppm mercury. There are brands out there that are mercury free or low mercury guaranteed. Something to think about. If you have thyroid issues they usually contain high iodine concentrations also. One member had an episode of high iodine toxicity I couldn't find a iodine free product. If your thyroid is fine then this should not be an issue.
FH - Cod liver oil you buy in the store may be high in mercury and pesticides. The liver is the pollutant filter for the body. Cod livers are from the top of the food chain and pollutant levels are usually significant. Be sure to get one that is purified and verified mercury free. But I don't believe there is one verified pesticide free. Great care must be used in selecting one. It also contains fairly significant levels of vitamin A and D and toxic doses are known to occur. Routine blood analysis for Vit A and D should be done every 6 months if using Cod Liver Oil or any Fish oil.
Omega 3
3 Grams of omega 3 per day can worsen cardiac arrythmias.

#5 fishinghat


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Posted 20 July 2023 - 12:44 PM

I only found one medical research article on the use of antidepressants for PMDD. It showed a significant improvement in depression with their use.
As far as testosterone and PMDD...
Nociceptive processing in women with premenstrual dysphoric disorder (PMDD): the role of menstrual phase and sex hormones
Objective: Premenstrual dysphoric disorder (PMDD) is associated with increased pain, but there has been a lack of well-controlled research assessing pain responsivity, sex hormones, and their relationships in this group. This study was designed to address this gap in the literature.
Materials and methods: Healthy, regularly cycling participants (14 PMDD, 14 non-PMDD) attended pain testing sessions during the mid-follicular, ovulatory, and late-luteal phases of the menstrual cycle (order counterbalanced) and salivary estradiol, progesterone, and testosterone were assessed at each testing session. Pain sensitivity was measured from electrocutaneous threshold/tolerance, ischemic threshold/tolerance, sensory and affective ratings of electrocutaneous and ischemic stimuli, and the nociceptive flexion reflex threshold (NFR, a measure of spinal nociception).
Results: Women with PMDD had higher sensory pain ratings of electrocutaneous stimuli and trends for lower ischemic thresholds and higher affective pain ratings of electrocutaneous stimuli. However, there were no group differences observed in NFR threshold. Testosterone levels were also lower during the mid-follicular and ovulatory phases in PMDD. Correlations between pain outcomes and estradiol and testosterone indicated that these hormones are hypoalgesic, with estradiol having a greater hypoalgesic effect within the PMDD group.
Discussion: Overall, women with PMDD may have a phase-independent hyperalgesia, with pain amplification likely occurring at the supraspinal level rather than the spinal level, given the lack of group differences in NFR threshold. Because testosterone was hypoalgesic and lower in women with PMDD, and there were strong associations between pain and estradiol in PMDD, sex hormones may play a role in PMDD-related hyperalgesia.
Fishinghat's Note - There is an abundance of evidence that low testosterone can often lead to depression, even in women.
Variation in genes and hormones of the hypothalamic-pituitary-ovarian axis in female mood disorders - A systematic review and meta-analysis
Women's increased risk for depression during reproductive transitions suggests an involvement of the hypothalamic-pituitary-ovarian (HPO) axis. This is the first systematic review and meta-analysis of HPO functioning in female mood disorders. Inclusionary criteria were: i) women suffering from premenstrual dysphoric disorder (PMDD) or a depressive disorder, ii) assessment of HPO-axis related biomarkers, iii) a case-control design. Sixty-three studies (N = 5,129) were included. There was evidence for PMDD to be paralleled by lower luteal oestradiol levels. Women with depression unrelated to reproductive transition showed lower testosterone levels than healthy controls and there was some evidence for lower dehydroepiandrosterone sulfate levels. There were no differences in HPO-related parameters between women with pregnancy, postpartum, and perimenopausal depression and controls. Women with PMDD and depression unrelated to reproductive transitions exhibit specific changes in the HPO-axis, which potentially contribute to their symptoms. Further research into reproductive mood disorders characterised by extreme endocrine changes is warranted.
Six studies investigated testosterone ( Amsterdam et al., 1981, 1983;Antonijevic et al., 2003;Young et al., 2000;Rajewska and Rybakowski, 2003;Erdinçler et al., 2004;Findikli et al., 2017;[7] ). Meta -analysis revealed that depressed women presented with lower testosterone levels than healthy controls 
As with PMDD, the testosterone finding was dependent on standardised morning sampling. This concurs with endocrinological guidelines suggesting that due to natural diurnal variation in testosterone levels, samples should be collected in the morning ( Bhasin et al., 2010 ). 
Fishinghat's note - It is critical that any testosterone tests be done as close to 1 hour after rising in the morning as this is when testosterone levels are at their highest.
Sex Hormones, Neurosteroids, and Glutamatergic Neurotransmission: A Review of the Literature
Glutamatergic dysfunction has been implicated in the pathophysiology of multiple conditions including epilepsy, chronic pain, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD), raising interest in potential ways of modifying glutamate in the nervous system. Emerging research has suggested an interactive effect between sex hormones and glutamatergic neurotransmission. The objective of this paper is to review existing literature on the mechanism of interaction between sex hormones and glutamatergic neurotransmission, as well as to explore what is known about these interactions in various neurological and psychiatric conditions. This paper summarizes knowledge regarding mechanisms for these effects, and glutamatergic response to direct modulation of sex hormones. Research articles were identified via scholarly databases including PubMed, Google Scholar, and ProQuest. Articles were included if they were original research from peer-reviewed academic journals that dealt with glutamate, estrogen, progesterone, testosterone, neurosteroids, glutamate and sex hormone interactions, or the potential impact of glutamate and sex hormone interactions in the following conditions: chronic pain, epilepsy, PTSD, and PMDD. Current evidence suggests that sex hormones can directly modulate glutamatergic neurotransmission, with specific protective effects against excitotoxicity noted for estrogens. An effect of monosodium glutamate (MSG) consumption on sex hormone levels has also been demonstrated, suggesting a possible bi-directional effect. Overall, there is a good deal of evidence suggesting a role for sex hormones, and specifically for estrogens, in the modulation of glutamatergic neurotransmission.

#6 fishinghat


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Posted 20 July 2023 - 05:09 PM

Just a little personal story that you might find interesting.


My wife (65) suffers from postmenopausal syndrome which is characterized by low prolactin, estrogen and testosterone, Even far below what is expected for the average postmenopausal women. We saw her Ob/Gyn and and she ordered the labs which confirmed the diagnosis. She said that within that medical group they are allowed only to do one women's hormone test and no more after that.  The original lab results were, per policy, sent to a compounding pharmacist to come up with a biogenic cream to treat the condition. No prolactin, no testosterone only estrogen which was normal for her situation. When we talked to the compounding pharmacist they said that estrogen is usually what is prescribed for women going through menopause. I told him that she was 65 and many years past her menopause and he said, well that is just the way it is. In discussions with her primary care dr, ob/gyn and an endocrinologist it is that medical establishments policy NOT to test or pursue treatment of postmenopausal syndrome. Subsequently I have been in touch with other medical groups in my area and they all have the same policy. I guess you just deal with it until you die. Many of these groups said that there are women's hormone clinics in our area but checking on them I found out that they have poor reviews, insurance will not pay for them and many have a history of legal issues. 


Her situation is one that I will just have to deal with myself I guess. 

#7 mutalune



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Posted 22 July 2023 - 06:00 PM

First off - thank you so so much for your thoughtful responses. Seriously, thank you. I think this is the first time I've felt really seen in how difficult and confusing figuring all of this out is, because the fact that you could find so much research and information to fill multiple posts really goes to show how complex this is. And I really struggled with chemistry/biology/etc. in school, so it's hard to find actual solutions when your options for online research are "really dense scientific articles that take me hours to decipher" or "blogs written by people who think exercise and keto fixes everything." So thank you SO much for grabbing these articles and then also adding your comments with "here's the takeaway," as that was incredibly helpful to keep me from getting lost in the weeds.


Alright, getting into it all -


Current state after seeing psychiatrist earlier this week: I was on Cymbalta for 2.5 months altogether. I started at 20mg once a day at the beginning of May and we upped it to twice a day when I was waking up throwing up and having panic attacks, and they went "ah it must be because it's out of your system, let's try to keep it in your system then by having you take it right before you go to bed too!" which, you guessed it, just made me nauseous and anxious twice a day.


We're going from 20mg twice a day (morning and night) to 20mg once a day (morning), and I'll see her in 2 weeks to see how that's going. I'm a few days in and it's not GREAT but it's tolerable right now. She prescribed some clonidine after I mentioned it from having read your ebook, which has finally helped me get some decent sleep for the first time in ages, and that has made a HUGE difference. I'm def still not at 100%, and it kinda sucks to pretty much be able to set a clock by the way my body knows exactly when my morning dose is wearing off and my body starts jonesing for the second dose because it hits about 7PM and my heart starts pounding and it feels like the world is ending... but I feel a lot more capable of handling things moving forward, and I'm not as quick to get to the "oh god how will I get through this," level of panic that was driving my original post. This is temporary and I'm going to get through this like I've gotten through every other crap situation life has thrown at me so far. AND I have your helpful Do's and Don't's list, which leads me to my response to everything you said:


1) The Do's and Don't's is a HUGE help, thank you. I don't think I realized how much caffeine is in a lot of stuff? I don't drink coffee or tea or energy drinks so I always thought that I was pretty good about not having too much of it, but wow. A big miss is chocolate - I def comfort eat and that's a go-to for me, which I'm going to try to keep to a minimum in the upcoming weeks. Another one on the don't list that is possibly common sense but I was missing is marijuana - I've used it for occasional bouts of insomnia, but with how sensitive anxiety-wise I've been since we started tapering, it's probably best to stay away from it for now.


2) I'm going to make a vitamin/mineral run to the store tomorrow, because there's a few on the list you provided that I haven't tried yet (magnesium being a big one I've been meaning to add in for ages since it comes up frequently when you look up depression and PMDD, and since you and my psychiatrist both mentioned it, that's probs a good one to start with.) I think my doc said 400mg for magnesium, but I'll double check on that b/c I can't remember exactly. Omega3 and L-theanine are ones that I haven't come across that I'll look into and make sure are cool for me to take as well.


3) I've gotten blood, thyroid, and genetic testing done - The blood and thyroid were when we were trying to figure out if my symptoms were mental-health or physical-health, probs in early 2020, and I pretty much got the "you have low iron and low b12 + your sugar's in the prediabetic range but otherwise you're cool" response and the thyroid testing was in normal ranges according to the endocrinologist I saw. (That being said, she was the most dismissive doctor I've ever seen in my life and the minute she decided I didn't have a thyroid problem, she told me to leave, so I might look into getting a second opinion since it's been a few years and I'm still having a rough time despite the many different meds I've tried.) I've gotten out of the habit of taking my iron and b12 because I've been struggling and honestly didn't notice much of a difference when taking them, but this is a good reminder that now's as good as any time to add them back in and it can't hurt.


4) The genetic testing is recent - I did that on my own through sequencing.com and only got the results recently, and I wish I had waited until I saw the links you have, because Sequencing was both significantly more expensive than the Genesight link you shared and it seems like you get a LOT more support with them, whereas with Sequencing I've been left with a crap ton of information and no clue what most of it means. (It's kind of cool because if you know the name of a gene you can go search through your genome to see it specifically, but like. Nothing is explained well at all, it's not clear if they're saying "hey this gene variation was detected and that means you have this thing versus it means you're at RISK of having this thing," their FAQs aren't great - and most frustratingly, I paid extra for a report specifically to tell me about my response to medications specifically for this reason and all it tells me is that I'm bad at metabolizing the CYP2C9 enzyme, which means next to nothing to me. Plus a lot of the reports seem to contradict each other. So just as an FYI if you hear about other folks on here trying out genetic testing that Sequencing wouldn't be my first pick unless you're WAY more science-literate than I am and way more tolerant of their "you have to pay for every report, even though the reports are crappy and like 4 pages of BS" scam.)


SO the main point of me saying all of this is while I got it done, I haven't really gotten much use out of it yet. The one thing I know it said is that I metabolize most medication classes faster, so it's likely that the nausea/etc. I was having with a few hours before my Cymbalta doses was almost like a mini-withdrawal. I'll bring the testing up with my psychiatrist and see if there's something we can look into there, theoretically since I've had the analysis done and I own the data, I can get someone smarter than me to take a look at it and point out if there's stuff I should be cognizant of, and she might have some guidance on what to look for.


5) With all of that though, what you said that was super surprising to me was the testosterone link to depression and PMDD. I already know that I'm sensitive to estrogen according to my docs (see: blood clots from being on hormonal BC lmao) but it never occurred to me to get my testosterone levels checked or even look at that as a possible link. If i remember right I saw something in my Sequencing info that said something about a "possible detection/carrier" for testosterone deficiency that I didn't even give a thought to since I'm not male. Do you think this is a "mention to my PCP/gynecologist" thing that they'd be able to help with, or should I go in assuming I'll need a referral to an endocrinologist?


6) I'm sorry that your wife is going through that and that the medical system is weirdly against even attempting to help. That's absolutely bizarre (and f*cked up!!!) that their policy is "sucks to suck, suffer for the rest of your life," rather than even attempt some kind of treatment. And then the places that possibly could help sound like trash? That's so unfortunate. She's lucky to have you to support her and help research everything. I'm only 27 and I'm already getting disillusioned with how much the doctors that you should be able to trust to help are either overworked or dispassionate enough that they rarely help you figure out a solution instead of just throwing the most common solution at you and shrugging when it doesn't work, so I can't imagine how frustrating this must be for you two. Menstrual and menopausal health is such an understudied field and I really feel for your wife's situation.



FH, your name might not be Obi-Wan, but you've definitely helped. At the very least, I feel a lot more equipped to get through the next however-long this will take, and having some things to try makes me feel less like I'm just sitting around suffering and more like there's still options to try. Plus, you helped me feel way less insane/out-of-control and generally alone just by responding. I seriously appreciate it.

#8 fishinghat


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Posted 23 July 2023 - 07:37 AM

A few notes.


It is generally recommended not to exceed 300 mg/day on magnesium as it competes with calcium in the body. Too much magnesium can lower calcium levels.


I am glad that you are not taking the iron anymore. It is possible to build-up toxic levels of iron in your system before any side effects show up. When taking iron supplements it is important to have routine blood tests to determine serum iron levels.


If you have specific questions or would just like me to look over the gene sequencing results just send them to me by PM if you are comfortable doing that. 


"I'm bad at metabolizing the CYP2C9 enzyme, which means next to nothing to me."  Oh boy, this is very important. The cyp enzymes is what processes medications and food in the liver. As soon as I get time I will try and look into that specific one and determine what meds it effects as well as foods. i think I have a database on that somewhere. lol


Testosterone is nearly important for women as men as it has such a pronounced effect on pain and emotions.


Lastly, I really appreciate the kind words about my help. I hate to see people suffer anymore than necessary. Don't think too bad of the drs. They work an assembly line just like a factory worker and get burned out and fatigued just as easily. In addition, there is over 300 new medical research articles published every week and with their work load they simply can not keep up. As soon as they graduate from medical school they are outdated.


Hang in there and we will deal with your issues as best we can. Do remember, while I have advanced degrees I am NOT a dr so keep that in the back of your mind. i do try to lean on scientific data to clarify a problem though. 

#9 fishinghat


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Posted 24 July 2023 - 12:24 PM

These drugs are processed or react with the liver enzyme cyp2C9. When taking these drugs you may need to increase or decrease the dosage to get a normal effect depending on whether it absorbs easier or slower with your genetic version of CYP2C9.
Drugs and compounds which inhibit or antagonize the biosynthesis or actions of CYTOCHROME P-450 CYP2C9.
Abemaciclib A medication used to treat HR+ HER2- advanced or metastatic breast cancer.
Abiraterone An antiandrogen used in the treatment of prostate cancer.
Acetyl sulfisoxazole Acute, recurrent or chronic urinary tract infections (primarily pyelonephritis, pyelitis and cystitis) due to susceptible organisms (usually Escherichia coli, Klebsiella-Enterobacter, staphylococcus, Proteus mirabilis and, less frequently, Proteus vulgaris) in the...
Adagrasib A KRAS inhibitor indicated for the treatment of locally advanced or metastatic KRAS G12C-mutated non-small cell lung cancer in patients who have received at least one prior systemic therapy.
Agomelatine Agomelatine is indicated to treat major depressive episodes in adults.
Amiodarone A class III antiarrhythmic indicated for the treatment of recurrent hemodynamically unstable ventricular tachycardia and recurrent ventricular fibrillation.
Amlodipine A calcium channel blocker used to treat hypertension and angina.
Amodiaquine An antimalarial drug.
Anacaulase A mix of proteolytic enzymes indicated for eschar removal in adults with deep partial thickness and/or full-thickness thermal burns.
Anastrozole A competitive, selective, non-steroidal aromatase inhibitor used as adjuvant therapy for the treatment of hormone receptor-positive breast cancer in postmenopausal women.
Aprepitant A substance P/neurokinin 1 receptor antagonist used to treat nausea and vomiting caused by chemotherapy and surgery.
Armodafinil A stimulant used to improve wakefulness in adult patients with excessive sleepiness associated with obstructive sleep apnea, narcolepsy, or shift work disorder.
Asciminib An inhibitor of ABL/BCR-ABL1 tyrosine kinase for the treatment of patients with Philadelphia chromosome-positive CML, including those with the T315I mutation.
Atazanavir An antiviral protease inhibitor used in combination with other antiretrovirals for the treatment of HIV.
Atorvastatin An HMG-CoA reductase inhibitor used to lower lipid levels and reduce the risk of cardiovascular disease including myocardial infarction and stroke.
Atovaquone An antimicrobial indicated for the prevention and treatment of Pneumocystis jirovecii pneumonia (PCP) and for the prevention and treatment of Plasmodium falciparum malaria.
Avacopan An orally bioavailable complement 5a receptor (C5aR) antagonist for the treatment of severe anti-neutrophil cytoplasmic (auto)antibody (ANCA)-associated vasculitis.
Avapritinib A selective tyrosine kinase inhibitor being investigated for the treatment of multidrug resistant gastrointestinal tumors.
Avasimibe Investigated for use/treatment in peripheral vascular disease.
Azelastine A histamine H1-receptor antagonist used intranasally to treat allergic and vasomotor rhinitis and in an ophthalmic solution to treat allergic conjunctivitis.
Belinostat A histone deacetylase (HDAC) inhibitor used for the treatment of patients with relapsed or refractory peripheral T-cell lymphoma (PTCL).
Benzbromarone A uricosuric agent which is taken daily for the prevention of gout flares.
Bicalutamide An androgen receptor inhibitor used to treat Stage D2 metastatic carcinoma of the prostate.
Black cohosh A herbal product indicated in the symptomatic treatment of menopause.
Bortezomib A proteasome inhibitor used to treat multiple myeloma in patients who have not been successfully treated with at least two previous therapies.
Brincidofovir An oral lipid prodrug of cidofovir used in the treatment of human smallpox disease.
Candesartan An angiotensin-receptor blocker indicated in the treatment of hypertension.
Cannabidiol An active cannabinoid used as an adjunctive treatment for the management of seizures associated with Lennox-Gastaut syndrome or Dravet syndrome and symptomatic relief of moderate to severe neuropathic pain or other painful conditions, like cancer.
Cannabinol Cannabinol (CBN) is a physiologically inactive constituent of Cannabis sativa.
Capecitabine A nucleoside metabolic inhibitor indicated to treat different gastrointestinal, including pancreatic cancer, and breast cancer.
Cariprazine An atypical antipsychotic used to treat schizophrenia and acute manic or mixed episodes due to bipolar I disorder.
Casimersen An antisense phosphorodiamidate morpholino oligonucleotide used to treat Duchenne muscular dystrophy patients with mutations amenable to exon 45 skipping.
Ceritinib An antineoplastic kinase inhibitor used to treat anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) in patients with inadequate clinical response or intolerance to crizotinib.
Cerivastatin A statin (or HMG CoA reductase inhibitor) used with dietary changes to decrease lipid levels and reduce the risk of cardiovascular events.
Cimetidine A histamine H2 receptor antagonist used to manage GERD, peptic ulcer disease, and indigestion.
Cisapride A medication used to treat heartburn associated with GERD.
Cisplatin A platinum based chemotherapy agent used to treat various sarcomas, carcinomas, lymphomas, and germ cell tumors.
Clascoterone An androgen receptor antagonist used for the topical treatment of acne vulgaris in patients 12 years of age and older.
Clevidipine A dihydropyridine L-type calcium channel blocker used to lower blood pressure when oral antihypertensive therapy is not feasible or not desirable.
Clinafloxacin Clinafloxacin is a fluoroquinolone antibacterial currently under research. It has been proven to present good antibiotic properties. However, its approval and release have been halted due to the presence of...
Clobazam A benzodiazepine used as adjunct treatment in seizures associated with Lennox-Gastaut syndrome.
Clopidogrel An antiplatelet agent used to prevent blood clots in peripheral vascular disease, coronary artery disease, and cerebrovascular disease.
Clotrimazole A topical broad-spectrum antifungal agent used for the treatment of a wide variety of dermatophyte infections and candidiasis.
Crisaborole A non-steroidal topical medication used for the treatment of mild-moderate atopic dermatitis.
Curcumin No approved therapeutic indications.
Curcumin sulfate No approved therapeutic indications.
Cyclizine An antihistamine and antiemetic drug used for the prevention and treatment of nausea, vomiting, and dizziness associated with motion sickness, and vertigo.
Dabrafenib A kinase inhibitor used to treat patients with specific types of melanoma, non-small cell lung cancer, and thyroid cancer.
Delavirdine A non-nucleoside reverse transcriptase inhibitor used to treat HIV infection.
Dexloxiglumide For the treatment of Irritable Bowel Syndrome (IBS) and Gastroesophageal Reflux Disease (GERD).
Diacerein An slow-onset anthraquinone IL-1 inhibitor used in the treatment of degenerative joint diseases like osteoarthritis.
Diethylstilbestrol Used in the treatment of prostate cancer. Previously used in the prevention of miscarriage or premature delivery in pregnant women prone to miscarriage or premature delivery.
Diosmin A citrus flavonoid medication used to support vascular health.
Doconexent An omega 3 fatty acid used in a variety of nutritional supplements to support central nervous system and cardiovascular health.
Dosulepin A tricyclic antidepressant commonly used only in patients for whom alternative therapies are ineffective due to its toxicity potential.
Dronabinol A synthetic delta-9-THC used in the treatment of anorexia and weight loss in HIV patients as well as nausea and vomiting in cancer chemotherapy.
Efavirenz A non-nucleoside reverse transcriptase inhibitor used to treat HIV infection or prevent the spread of HIV.
Elexacaftor A small molecule CFTR corrector used in combination with tezacaftor and ivacaftor for the treatment of cystic fibrosis patients with one F508del-CFTR mutation.
Enasidenib An isocitrate dehydrogenase-2 inhibitor used to treat relapsed or refractory acute myeloid leukemia with an isocitrate dehydrogenase-2 mutation.
Epinephrine A hormone and neurotransmitter used to treat allergic reactions, to restore cardiac rhythm, and to control mucosal congestion, glaucoma, and asthma.
Estrone sulfate An estrogen used as monotherapy or in several combination hormone replacement products for managing menopause symptoms and hormone disorders.
Ethambutol An antituberculosis agent used in the prophylaxis and treatment of tuberculosis (TB).
Ethanol For therapeutic neurolysis of nerves or ganglia for the relief of intractable chronic pain in such conditions as inoperable cancer and trigeminal neuralgia (tic douloureux), in patients for whom neurosurgical...
Etoricoxib A selective COX-2 inhibitor used to relieve moderate post-surgical dental pain as a short-term treatment and inflammatory and painful symptoms of various forms of arthritis.
Etravirine A non-nucleoside reverse transcriptase inhibitor (NNRTI) used in the treatment of HIV-1 infections in combination with other antiretroviral agents.
Felbamate An anticonvulsant used to treat severe epilepsy.
Felodipine A calcium channel blocker used to treat hypertension.
Fenofibrate A peroxisome proliferator receptor alpha activator used to lower LDL-C, total-C, triglycerides, and Apo B, while increasing HDL-C in hypercholesterolemia, dyslipidemia, and hypertriglyceridemia.
Flecainide A class Ic antiarrhythmic agent used to manage atrial fibrillation and paroxysmal supraventricular tachycardias (PSVT).
Floxuridine An antimetabolite used as palliative management for liver metastases of gastrointestinal malignancy.
Fluconazole A triazole antifungal used to treat various fungal infections including candidiasis.
Fluorouracil A pyrimidine analog used to treat basal cell carcinomas, and as an injection in palliative cancer treatment.
Fluoxetine A selective serotonin reuptake inhibitor used to treat major depressive disorder, bulimia, OCD, premenstrual dysphoric disorder, panic disorder, and bipolar I.
Fluvastatin An HMG-CoA reductase inhibitor used to lower lipid levels and reduce the risk of cardiovascular disease including myocardial infarction and stroke.
Fluvoxamine A selective serotonin-reuptake inhibitor used to treat obsessive-compulsive disorder.
Gefitinib A tyrosine kinase inhibitor used as first-line therapy to treat non-small cell lung carcinoma (NSCLC) that meets certain genetic mutation criteria.
Gemfibrozil A lipid regulator that is used in the reduction of serum triglyceride levels in high-risk patients with hyperlipidemia.
Genistein Currently Genistein is being studied in clinical trials as a treatment for prostate cancer.
Ginkgo biloba A herbal supplement found in over-the-counter or unapproved homeopathic products for various health conditions, such as cognitive, neurodegenerative, cardiovascular, and reproductive health disorders.
Glyburide A sulfonylurea used in the treatment of non insulin dependent diabetes mellitus.
Imatinib A tyrosine kinase inhibitor used to treat a number of leukemias, myelodysplastic/myeloproliferative disease, systemic mastocytosis, hypereosinophilic syndrome, dermatofibrosarcoma protuberans, and gastrointestinal stromal tumors.
Iproniazid For the treatment of depression (originally intended to treat tuberculosis).
Isavuconazole Indicated for patients 18 years of age and older for the treatment of invasive aspergillosis [FDA Label]. Indicated for patients 18 years of age and older for the treatment of...
Isoniazid An antibiotic used to treat mycobacterial infections; most commonly use in combination with other antimycobacterial agents for the treatment of active or latent tuberculosis.
Ivacaftor A cystic fibrosis transmembrane conductance regulator (CFTR) potentiator used alone or in combination products to treat cystic fibrosis in patients who have specific genetic mutations that are responsive to the medication.
Ketoconazole A broad spectrum antifungal used to treat seborrheic dermatitis and fungal skin infections.
Ketoprofen An NSAID used to treat rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, dysmenorrhea, mild to moderate muscle pain, postoperative pain, and postpartum pain.
Lansoprazole A proton pump inhibitor used to help gastrointestinal ulcers heal, to treat symptoms of gastroesophageal reflux disease (GERD), to eradicate Helicobacter pylori, and to treat hypersecretory conditions such as Zollinger-Ellison Syndrome.
Leflunomide A pyrimidine synthesis inhibitor indicated to treat rheumatoid arthritis.
Lenvatinib A receptor tyrosine kinase inhibitor used for the treatment of metastatic thyroid cancer, advanced renal cell carcinoma in combination with everolimus, and unresectable hepatocellular carcinoma.
Levofloxacin A fluoroquinolone antibiotic used to treat infections caused by susceptible bacteria of the upper respiratory tract, skin and skin structures, urinary tract, and prostate, as well as for post-exposure treatment of inhaled anthrax and the plague.
Lifitegrast A medication used to treat dry eye disease.
Lobeglitazone Lobeglitazone was approved by the Ministry of Food and Drug Safety (South Korea) in 2013, and is being monitored by postmarketing surveillance until 2019. Lobeglitazone is not approved for use...
Lopinavir An HIV-1 protease inhibitor used in combination with ritonavir to treat human immunodeficiency virus (HIV) infection.
Lovastatin An HMG-CoA reductase inhibitor used to lower LDL cholesterol and reduce the risk of cardiovascular disease and associated conditions, including myocardial infarction and stroke.
Lumacaftor A protein chaperone used in combination with ivacaftor for the treatment of cystic fibrosis in patients who are homozygous for the F508del mutation in the CFTR gene.

#10 fishinghat


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Posted 24 July 2023 - 12:26 PM



Manidipine A dihydropyridine calcium channel blocker used to treat hypertension.
Medical Cannabis The use of the plant species Cannabis sativa and Cannabis indica, popularly known as marijuana, has gained popularity in recent years for the management of a wide variety of medical...
Medroxyprogesterone acetate A progestin used as a contraceptive and in the treatment of secondary amenorrhea, abnormal uterine bleeding, pain from endometriosis, endometrial and renal carcinomas, paraphilia in males, and GnRH-dependent precocious puberty.
Mefenamic acid An NSAID used to treat mild to moderate pain for no more than a week, and primary dysmenorrhea.
Menadione The primary known function of vitamin K is to assist in the normal clotting of blood, but it may also play a role in normal bone calcification.
Methimazole A thionamide antithyroid agent that inhibits the actions of thyroid peroxidase, leading to a reduction in thyroid hormone synthesis and amelioration of hyperthyroidism.
Methylene blue An oxidation-reduction agent used for the treatment of pediatric and adult patients with acquired methemoglobinemia.
Metronidazole A nitroimidazole used to treat trichomoniasis, amebiasis, inflammatory lesions of rosacea, and bacterial infections, as well as prevent postoperative infections.
Miconazole An azole antifungal with broad-spectrum activity used to treat fungal infections affecting the vagina, mouth and skin, including candidiasis.
Midostaurin An antineoplastic agent used to treat high-risk acute myeloid leukemia (AML) with specific mutations, aggressive systemic mastocytosis (ASM), systemic mastocytosis with associated hematologic neoplasm (SM-AHN), or mast cell leukemia (MCL).
Mifepristone A cortisol receptor blocker used to treat Cushing's syndrome, and to terminate pregnancies up to 70 days gestation.
Modafinil A stimulant used to improve wakefulness in patients with sleep apnea, narcolepsy, or shift work disorder.
Nabilone A synthetic delta-9-THC used in the treatment of anorexia and weight loss in HIV patients as well as nausea and vomiting in cancer chemotherapy.
Nevirapine A non-nucleoside reverse transcriptase inhibitor used as part of a management regimen for HIV-1 virus infection.
Nicardipine A calcium channel blocker used for the short-term treatment of hypertension and chronic stable angina.
Nifedipine A dihydropyridine calcium channel blocker indicated for the management of several subtypes of angina pectoris, and hypertension.
Nilotinib A kinase inhibitor used for the chronic phase treatment of Chronic Myeloid Leukemia (CML) that is Philadelphia chromosome positive and for the treatment of CML that is resistant to therapy containing imatinib.
Nilutamide An antineoplastic hormone used to treat prostate cancer.
Nitisinone A hydroxyphenylpyruvate dioxygenase inhibitor used as an adjunct to dietary restrictions for the treatment of hereditary tyrosinemia type 1 (HT-1), which causes intolerance to tyrosine containing foods.
Noscapine A non-sedating isoquinoline alkaloid used primarily for its antitussive properties.
Olanzapine An antipsychotic drug used in the management of schizophrenia, bipolar 1 disorder, and agitation associated with these disorders.
Opicapone A catechol-O-methyltransferase inhibitor used as an adjunct treatment for Parkinson's Disease in adults currently receiving levodopa and a dopa decarboxylase inhibitor.
Oritavancin An antibacterial agent used to treat acute bacterial skin and skin structure infections caused by susceptible Gram-positive bacteria.
Oxandrolone An androgenic hormone used to treat muscle loss from prolonged corticosteroid treatment and to treat bone pain associated with osteoporosis.
Paroxetine A selective serotonin reuptake inhibitor used to treat major depressive disorder, panic disorder, OCD, social phobia, generalized anxiety disorder, the vasomotor symptoms of menopause, and premenstrual dysphoric disorder.
Pexidartinib An antitumor agent that is used for the treatment of rare disease tenosynovial giant cell tumors (TGCT) by inhibiting colony-stimulating factor 1 and its receptor.
Phenylbutazone An NSAID used to treat backache and ankylosing spondylitis.
Phenytoin An anticonvulsant drug used in the prophylaxis and control of various types of seizures.
Pirfenidone An agent used for the treatment of idiopathic pulmonary fibrosis (IPF).
Pirtobrutinib A kinase inhibitor used to treat relapsed or refractory mantle cell lymphoma (MCL) after at least two lines of systemic therapy.
Pralsetinib A RET receptor tyrosine kinase inhibitor for the treatment of metastatic RET-driven non-small cell lung cancer.
Pranlukast A leukotriene receptor antagonist for the treatment of allergic rhinitis and asthma symptoms.
Probenecid A medication used to treat gouty arthritis, tophaceous gout, and hyperuricemia.
Progesterone A hormone used for a variety of functions, including contraception, control of abnormal uterine bleeding, maintenance of pregnancy, and prevention of endometrial hyperplasia.
Promethazine A first-generation antihistamine used for the treatment of allergic conditions, nausea and vomiting, and motion sickness.
Quercetin A natural flavonoid found in foods and natural supplement products.
Quinidine A medication used to restore normal sinus rhythm, treat atrial fibrillation and flutter, and treat ventricular arrhythmias.
Rabeprazole A proton pump inhibitor used to help gastrointestinal ulcers heal, to treat symptoms of gastroesophageal reflux disease (GERD), to eradicate Helicobacter pylori, and to treat hypersecretory conditions such as Zollinger-Ellison Syndrome.
Regorafenib A kinase inhibitor used to treat patients with metastatic colorectal cancer, unresectable, locally advanced, or metastatic gastrointestinal stromal tumors, and hepatocellular carcinoma.
Resveratrol Being investigated for the treatment of Herpes labialis infections (cold sores).
Rhein No approved indication.
Rifamycin An antibacterial used to treat traveler's diarrhea.
Rilpivirine A non-nucleoside reverse transcriptase inhibitor (NNRTI) used in combination with other antiretrovirals to specifically treat human immunodeficiency virus type 1 (HIV-1).
Rosiglitazone A thiazolidinedione indicated as an adjunct to diet and exercise to maintain glycemic control in type 2 diabetes.
Rucaparib A poly (ADP-ribose) polymerase (PARP) inhibitor used to treat recurrent ovarian and prostate cancers in previously treated adults.
Seproxetine Seproxetine is also known as (S)-norfluoxetine. It is a selective serotonin reuptake inhibitor (SSRI). It is an active metabolite of fluoxetine. Seproxetine was being investigated by Eli Lilly as an...
Sertraline A selective serotonin reuptake inhibitor (SSRI) indicated to treat major depressive disorder, social anxiety disorder and many other psychiatric conditions.
Sildenafil A phosphodiesterase inhibitor used for the treatment of erectile dysfunction.
Simvastatin An HMG-CoA reductase inhibitor used to lower lipid levels and reduce the risk of cardiovascular events including myocardial infarction and stroke.
Sitaxentan Investigated for use/treatment in pulmonary hypertension, connective tissue diseases, hypertension, and congestive heart failure.
Sorafenib A kinase inhibitor used to treat unresectable liver carcinoma, advanced renal carcinoma, and differentiated thyroid carcinoma.
Stiripentol An antiepileptic agent used in combination with other anticonvulsants to treat seizures associated with Dravet syndrome.
Sulconazole A topical antifungal agent used for the treatment of tinea cruris, tinea corporis, and tinea versicolor caused by susceptible fungal strains.
Sulfadiazine A sulfonamide antibiotic used in a variety of infections, such as urinary tract infections, trachoma, and chancroid.
Sulfadimethoxine For use in the treatment of infections.
Sulfamethizole A sulfonamide antibiotic used to treat a wide variety of susceptible bacterial infections.
Sulfamethoxazole An oral sulfonamide antibiotic, given in combination with trimethoprim, used to treat a variety of infections of the urinary tract, respiratory system, and gastrointestinal tract.
Sulfamoxole For the treatment of bacterial infection.
Sulfaphenazole For the treatment bacterial infections.
Sulfapyridine A sulfonamide antibiotic used to treat dermatitis herpetiformis, benign mucous membrane pemphigoid and pyoderma gangrenosum.
Sulfinpyrazone A platelet inhibitory and uricosuric agent used to inhibit thrombotic and embolic processes and to manage the chronic phases of gout .
Sulfisoxazole A sulfonamide antibiotic used with other antibiotics to prevent and treat a variety of bacterial infections.
Suprofen An NSAID used to prevent pupil constriction in ocular surgery.
Tamoxifen A selective estrogen receptor modulator used to treat estrogen receptor positive breast cancer, reduce the risk of invasive breast cancer following surgery, or reduce the risk of breast cancer in high risk women.
Telotristat ethyl A tryptophan hydroxylase inhibitor that is used to treat carcinoid syndrome diarrhea.
Teniposide A cytotoxic drug used as an adjunct for chemotherapy induction in the treatment of refractory childhood acute lymphoblastic leukemia.
Tepotinib An oral tyrosine kinase inhibitor targeted against MET for the treatment of metastatic non-small cell lung cancer in patients exhibiting MET exon 14 skipping mutations.
Ticagrelor A P2Y12 platelet inhibitor used in patients with a history of myocardial infarction or with acute coronary syndrome (ACS) to prevent future myocardial infarction, stroke and cardiovascular death.
Ticlopidine A platelet aggregation inhibitor used in the prevention of conditions associated with thrombi, such as stroke and transient ischemic attacks (TIA).
Tienilic acid For the treatment of hypertension.
Tirbanibulin A tyrosine kinase and tubulin inhibitor used to treat actinic keratosis on the face or scalp.
Tolcapone A catechol-O-methyltransferase (COMT) inhibitor used as adjunct therapy in the symptomatic management of idiopathic Parkinson's disease.
Topiroxostat Indicated for the treatment of gout and hyperurcemia in Japan.
Torasemide A diuretic used to treat hypertension and edema associated with heart failure, renal failure, or liver disease.
Tranylcypromine A monoamine oxidase inhibitor used to treat major depressive disorder.
Triclabendazole An anthelmintic drug used to treat fascioliasis.
Troglitazone For the treatment of Type II diabetes mellitus. It is used alone or in combination with a sulfonylurea, metformin, or insulin as an adjunct to diet and exercise.
Ubrogepant An oral CGRP antagonist used in the acute treatment of migraine with or without aura.
Vadadustat An oral hypoxia-inducible factor prolyl-hydroxylase inhibitor used to treat symptomatic anemia associated with chronic kidney disease in adults on chronic maintenance dialysis.
Valdecoxib A COX-2 inhibitor used to treat osteoarthritis and dysmenorrhoea.
Valproic acid An anticonvulsant used to control complex partial seizures and both simple and complex absence seizures.
Valsartan An angiotensin-receptor blocker used to manage hypertension alone or in combination with other antihypertensive agents and to manage heart failure in patients who are intolerant to ACE inhibitors.
Vardenafil A phosphodiesterase 5 inhibitor used to treat erectile dysfunction.
Vemurafenib A kinase inhibitor used to treat patients with Erdheim-Chester Disease who have the BRAF V600 mutation, and melanoma in patients who have the BRAF V600E mutation.
Verapamil A non-dihydropyridine calcium channel blocker used in the treatment of angina, arrhythmia, and hypertension.
Vismodegib A hedgehog pathway inhibitor used to treat patients with locally advanced or metastatic basal cell carcinoma.
Voriconazole A triazole compound used to treat fungal infections.
Zafirlukast A leukotriene receptor antagonist used for prophylaxis and chronic treatment of asthma.
Zucapsaicin A topical analgesic used as an adjunct to relieve severe pain of osteoarthritis of the knee in selected adult patients.

#11 mutalune



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Posted 24 July 2023 - 04:59 PM

1) Magnesium note appreciated - I'm going to shoot my doc a message and get confirmation on what dose she was recommending, because the after visit summary still says 400mg which sounds high both based on what you're saying and what I've read myself.

2) Iron note ALSO appreciated - I didn't know that was something I should be monitoring with regular blood tests, which means I should probs go see my PCP before starting to take it again.

3) I don't have anything specific with the gene sequencing stuff right now, and I think I'll probably wait to dig in until I'm a bit more settled re: meds situation, but once I start diving in, I might shoot you a DM about the bits that get confusing. I'm hoping my psychiatrist will have an idea on if there's anything specific I should keep an eye out for and that'll give me a starting point, ya know?

4) The list of medications you provided that are affected by the CYP2C9 enzyme is interesting when I'm thinking about some of the reaction times I've been having with different medications. The other thing my genetic testing explicitly said is that I have "an accelerated response to most antidepressant drug treatment" (which I think explains why Cymbalta withdrawal kicked in before the usual 8-12hrs of its half-life, why taking it every 12hrs was still giving me those symptoms), but the ones on that list you provided that I have tried (Zoloft/sertraline, Prozac/fluoxetine), I generally was getting results that weren't as affected by me missing a dose since I'm assuming those would have more time in my system before being broken down by the enzyme since said enzyme isn't metabolized as quickly/well by my system (I wouldn't necessarily get the results that I wanted, but results nonetheless lol).

Not really anything to do with that info at this exact moment I don't think, but it was kind of an, "oh yeah, that makes sense," moment lol.

5) You're right, doctors are just people too. I think it's easy to hold them to an unrealistic standard since we rely on them for such sensitive topics (like. Our lives and health and well-being lol) but they have their own stuff going on, and the medical field is confusing and broad as hell. I work in tech and I know I can't keep up with everything that's always changing, esp if it's not relevant to my specific field, so it probs isn't fair to expect every doctor to know everything about a topic just because it's a topic that's affecting my life personally. I appreciate the reality check - I don't want to be unkind/bitter just because I'm having a rough time.

And yes I promise I won't expect you to magically fix all of my problems and be a medical expert!!! :lol: I appreciate your help and I've been researching on my own, cross-referencing what you're telling me with the info I already know, and I'm not making any decisions without consulting with my care team first. I'm just happy to have some new perspective + ideas to share with said care team that they might not have thought of on their own, and I know I wouldn't have thought of half of these things without your input and this forum :) 


Also an update if anyone's curious: 5 days since we decreased my cymbalta dose, and while the nighttime nausea/anxiety is pretty brutal, I'm stocked up on gatorade and vitamin C as well as a bunch of craft supplies to keep my hands busy when the anxiety gets rough. I'm working on a diamond painting of a flower currently lol and I foresee Michael's getting a good bit of business from me in the next few weeks.

#12 fishinghat


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Posted 24 July 2023 - 05:06 PM

That all sounds good Mutalune. Have patience. Your body will tell you when you are ready for another drop.


Hang in there and let me know if I can help with anything.

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