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Dr John B
Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience:  PhD in Clinical Psychology, registered clinical psychologist.
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Ive been on cymbalta for two years now for anxiety. Ive never

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I've been on cymbalta for two years now for anxiety. I've never slept well. My doctor is having me wean off it and add celexa. I'm worried the celexa wont be enough for me. I also have panic attacks.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr John B replied 2 years ago.

Hi,

Sorry to hear of the situation. Can you tell me if you have received a formal diagnosis? Can you provide some history of the problem - when did the PAs start in relation to the sleep problems? Is your doctor a general doctor or a Psychiatrist? Have you received any form of treatment other than medication?

Customer: replied 2 years ago.
Originally I did see a Psychiatrist that prescribed the Cymbalta for anxiety. I had some counseling. Now my general doctor prescribes it for me. Panic attacks started before my divorce and I had one bad one after, but usually I don't have them. I think the Cymbalta makes it hard to sleep. She also gave me Klonopin, but it didn't seem to do much.
Expert:  Dr John B replied 2 years ago.
Thanks for the extra information Deb. Can you tell me a bit about your original problem with 'anxiety' - what exactly were you experiencing?
Customer: replied 2 years ago.
I've had anxiety since childhood. Mood swings, easily irritated, worry too much, and continuing bad dreams. Exercise helps me a lot, but I still would get angry too easy.
Expert:  Dr John B replied 2 years ago.
Did you experience any serious trauma when you were younger?
Customer: replied 2 years ago.
When I was 19 my boyfriend commited suicide. Also my Father was an alcoholic in and out of treatment. Mom hid it from me until High School, but she was very angry because of it. He wasn't ever abusive, but yelled pretty loud when I did something wrong. I was always super sensitive.
Expert:  Dr John B replied 2 years ago.

Ok, sounds like a difficult childhood.

I'm trying to get a sense of the type of anxiety problem that is the underlying difficulty. You mention that you worry too much....how much? How often and about what kind of things? Also, can you tell me if the Psychiatrist gave you a formal diagnosis?

This question may seem a little out of the blue but have you ever had difficultly with self-harming? For example, cutting or bruising yourself?

Customer: replied 2 years ago.
I worry about too much about how I look, take forever to get ready to go anywhere, always late. The psychiatrist said I had depression and anxiety and that I needed to do something for myself like take a class or something. I've never hurt myself, but I drink too much and seem to bruise easily.
Expert:  Dr John B replied 2 years ago.
Is the worrying limited to social situations and relationships? How is your anxiety when you are in public?
Customer: replied 2 years ago.
Yes, it is, and I am fine in public.
Expert:  Dr John B replied 2 years ago.
How would you describe your self esteem? Just to clarify, did you ever have sleep difficulty prior to taking medication?
Customer: replied 2 years ago.

I always had low self esteem. My Mother and my ex-husband were very controlling and I let them run my life and make most decisions. I'm feeling better about that now that I'm divorced, but Mom still trys to control my decisions, and I have to work hard to not let that happen. I did have sleep problems before.

Expert:  Dr John B replied 2 years ago.

In your opinion is the anxiety or low mood the bigger problem?

Customer: replied 2 years ago.
Low mood. I find it very hard to get things accomplished.
Expert:  Dr John B replied 2 years ago.

Do you have trouble motivating yourself to start a task or do you have trouble concentrating on completing a task?

Does the sleep difficulty vary in relation to your mood?

Customer: replied 2 years ago.
I have trouble completing tasks. I start a lot of things at once and have trouble finishing them. Yes sleeping varys with my mood.
Expert:  Dr John B replied 2 years ago.

Ok, and were you being prescribed the Cymbalta for anxiety or Depression? That is, did the Psychiatrist consider your mood to be the primary problem or your anxiety?

Has your doctor explained why they are ceasing the Cymbalat now? Also, how much alcohol are you consuming?

Customer: replied 2 years ago.
The psychiatrist thought my mood was the biggest problem. Lately I've been drinking every night at least 4 or 5 drinks. I plan on stopping now. I have two kids I need to be healthy for. General doc thought my ex-husband was biggest problem, and wanted me off all meds, I asked to try Celexa because I think I will still need something.
Expert:  Dr John B replied 2 years ago.

Ok, I think I get the picture now.

I'm sure you already know this and I acknowledge that you plan to stop drinking but I still have to mention this:

The alcohol will could make the situation much, much worse. While alcohol is very effective in reducing anxiety in the short term it makes it worse once it wears off and exacerbates anxiety problems over the longer term. That is the anxiety will become more intense once the alcohol is processed from your body. It also disturb the sleep cycle.....and lowers mood.....and has potential dangerous interaction side effects with Cymbalta.

Enough said on that.

As far as getting the proper treatment for Depression you should have also been receiving Cognitive Behavioral Therapy (CBT) in conjunction with antidepressant medication.


The recommended sequence of treatments to try is:

1) Self-help using a CBT based program


2) CBT with a therapist


3) CBT & an antidepressant medication (usually a Selective Serotonin Re uptake
Inhibitor)


You can confirm that this is the correct order by checking these treatment
recommendations here.


So, as you can see you haven't really been provided with the full and proper treatment approach.

CBT is a psychotherapeutic approach that aims to solve problems concerning dysfunctional emotions, behaviors and cognitions through a goal-oriented, systematic
procedure. Treatment is technique driven, brief, direct and time-limited (normally 10-12 sessions). CBT is used in individual therapy as well as group settings, and the techniques are often adapted for self-help applications. I would strongly encourage you to consider CBT as I would expect you get great benefit from this approach.


Start by working through this excellent CBT based self-help program here. It should take several weeks to complete, is completely free and will teach you everything you need to know about Depression and what you can do about it. Alternatively, you could take a look at a book which will teach you some introductory techniques for dealing with Depression at home. I can recommend a well known manual titled Mind Over Mood and another book titled The Cognitive Behavioral Workbook for Depression; A Step by Step Program as good places to start. You can find them
both here.


If you find you aren't making the kind of progress you would like using a self-help approach I would then recommend you consult with a CBT trained therapist. CBT is usually offered by Clinical Psychologists (although not exclusively) and you can contact the American Psychology Association (APA) for assistance with locating a Psychologist; take a look at the APA locator service here. You can use this to find Psychologists in your area and there is a phone number you can contact if you want a referral arranged for you. Also, take a look at an article published by the APA here. It's an interview with a senior Psychologist and covers some of the things you should consider when you looking for a Psychologist.


It is entirely reasonable for you to request continuation of antidepressant medication at this time and hopefully you will be able to reduce the need to use it as you begin to use CBT effectively.

I'll pause at this point and wait for your response to what I have written here.

Customer: replied 2 years ago.

Thank you so much. I will try that program as you suggested and look for the books at the library. In your opinion is Cymbalta a good option to stay with or the Celexa?

Expert:  Dr John B replied 2 years ago.

You are very welcome. I can't give specific medication recommendations as I'm a Psychologist not a Psychiatrist but I would point out two things:

1) Cymbalta can have dangerous interactions with alcohol

2) You've been using Cymbalta for a couple of years and antidepressants in general are only supposed to be used for a limited time.

I would follow the recommendation of your current doctor.

If you have any further questions or would like me to clarify or elaborate on any part of my answer please let me know. If not.....I wish you the best of luck!

Dr John B, Psychologist
Category: Mental Health
Satisfied Customers: 557
Experience: PhD in Clinical Psychology, registered clinical psychologist.
Dr John B and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.

Thank you. I am going to try the self help methods you mentioned and exercise more. I am going to try to wean off cymbalta.


Thank you very much.

Expert:  Dr John B replied 1 year ago.
Hi Deb,

I hope you are making some progress with the self-help approach and reducing the Cymbalta. If I can be of further help, or if you ever have other questions in the future, please don't hesitate to contact me directly. You can do this by simply putting "For Dr John B" at the start of any question you post.

Regards,

John

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