Psychiatry & Psychology--General/SNRI

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QUESTION: Hello doctor what is your experience with SNRI's such as cymbalta on panic disorder with agoraphobia?

I was on paxil CR it works well, however I was getting unwanted side effects like dry eyes which inturn was worsing my allergic conjuctivitis (I have a history of allergies) the doctor wants me to try cymbalta.

I'm not concerned rather just looking to know if its effective I mean what exactly does the noradrenalin component of the drug do? Does it help anxiety?

I limit my caffeine and I'm just wondering how can cymbalta help if I'm going to have more adrenalin circulating in my system?

I usually focus a lot on my heart and I do get ectopic beats I just don't want cymbalta to make it worse. I guess one has to try to know.

Paxil gives me terrible insomnia and horrible like dryness and stomach issues. It also blunts my emotions a lot like I feel nothing for anything and it also made me angry and irritated. I could not simply relax.

ANSWER: SNRI's are not quite as good as SSRI's with panic, but do work in many people.  If you have no history of substance abuse, you may also want to consider Benzodiazepines although they must be taken multiple times during the day, which can be a problem.

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QUESTION: I've very into exercise and training so I try limit benzodiazapine. I'm on day 4 on cymbalta 30mg safe to say my sleep is better and I feel good. Paxil CR I'm on 12.5mg. Benzodiazapines make me sluggish impair my memory. My panic is under control at present my question is

Can an SNRI help with panic disorder thought not the preffered treatment is their cases where people actually better off on snri?

I do get ectopic beats sometimes can an SNRI provoke them?

With paxil I felt very lethargic the past 4 days I've actually had some energy feeling good with cymbalata.

I'd like to ask you this question it may sound stupid if a person has too much or too less serotonin does this cause anxiety problems? And if a person has to less noradrenaline or too much can that also cause anxiety problems?

To mee I feel I have too much in my system because I don't feel as lethargic

My doctor tells me that at 30-60mg cymbalta acts more as an ssri that snri

Answer
I do get ectopic beats sometimes can an SNRI provoke them? No, anxiety provokes these.;

I'd like to ask you this question it may sound stupid if a person has too much or too less serotonin does this cause anxiety problems? This is unknown; we cannot measure Serotonin

Psychiatry & Psychology--General

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Daniel S. Harrop, M.D.

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Dr. Daniel S. Harrop received his B.A. and his M.D., both from Brown, and his M.B.A. from the Edinburgh Business School, Scotland. Board-certified in adult and geriatric psychiatry, he is a past president of the R.I. Psychiatric Society and a member of the Committee on Medical Quality of the American Psychiatric Association and the Committee on Continuing Medical Education of the R.I Medical Society. He serves as a consultant to four of the top five major medical management companies, including OptumHealth/United Healthcare, Magellan Behavioral Health Services, ValueOptions and APS Healthcare, and maintains a private practice in Providence, R.I. He also serves as chief psychiatric consultant on the Medical Advisory Board at the R.I. Workers Compensation Court. He was formerly on the faculty at the medical schools at both Brown University and Harvard University.

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