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Posted by: Boo123 | 2012/05/02

response to post 698

I disagree with you panic disorder can start a chain of avoidance behavior and agoraphobia...Having said that as you know my history from before I was on I found great efficacy on aropax cr 25mg however the side effects I foind most distressing was the gastrointestinal effect it was too over bearing to continue I have tried other SSRIS but with limited efficacy however they all did keep panic attacks at bay its just aropax was very effective in controlling anxiety and panic. I''m now on cymbalta day 7 on 30mg from day 8 it goes to 60mg you would think its noradrenaline component would keep me alert but its been putting me off to sleep! I''ve been told to take it in the morning but I''m wondering if I should take it at night? Current side effect I''m experiecing are sexual dysfunction a some what weark erection and the lethargic tired feeling will this pass? I''ve been duloxetine has a much better side effect profile than SSRIs is this true?, what''s your opinion of the drug?

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Our expert says:
Expert ImageCyberShrink

Yes, there can indeed be such a chain of events - but panic disorder is, for good reasons, not recognized as a CAUSE of agoraphobia ( and why agoraphobia rather than other phobias ? ) - and emphasizing the supposed connection isn't especially USEFUL.
The chemical impact of the antidepressants is horribly complex. Because, for instance, even where we know that drug X predominantly impacts on brain chemical Y, that is only an initial part of it, as raising or lowering one brain chemical usually variably raises or lowers others as the brain tries to balance things out.
I don't see any reason at all why a once-a-day med which you find is as a side-effect causing you to feel drowsy, should be taken in the morning - it'd be well worth trying instead to take it at night, where the drowsiness would be welcome and useful.
With most drugs, most side-effects are most troublesome in the first few weeks on the drug, and tend to reduce or go away. I'm not at all convinced that Duloxetine has "a better side effect profile" than others like SSRI's" - this is the claim EVERY drug company makes for EVERY new and expensive drug, and with time more side-effects are recognized. I've not been especially impressed that Duloxetine has great advantages.
The newer antidepressant Agomelatine does seem, with a distinct chemical profile, to have less impact on sexual functions.

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Our users say:
Posted by: cybershrink | 2012/05/03

Yes, there can indeed be such a chain of events - but panic disorder is, for good reasons, not recognized as a CAUSE of agoraphobia ( and why agoraphobia rather than other phobias ? ) - and emphasizing the supposed connection isn't especially USEFUL.
The chemical impact of the antidepressants is horribly complex. Because, for instance, even where we know that drug X predominantly impacts on brain chemical Y, that is only an initial part of it, as raising or lowering one brain chemical usually variably raises or lowers others as the brain tries to balance things out.
I don't see any reason at all why a once-a-day med which you find is as a side-effect causing you to feel drowsy, should be taken in the morning - it'd be well worth trying instead to take it at night, where the drowsiness would be welcome and useful.
With most drugs, most side-effects are most troublesome in the first few weeks on the drug, and tend to reduce or go away. I'm not at all convinced that Duloxetine has "a better side effect profile" than others like SSRI's" - this is the claim EVERY drug company makes for EVERY new and expensive drug, and with time more side-effects are recognized. I've not been especially impressed that Duloxetine has great advantages.
The newer antidepressant Agomelatine does seem, with a distinct chemical profile, to have less impact on sexual functions.

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