Question: I take Zyprexa and Cymbalta for depression. I would like to get off the Zyprexa*. Is there another combo that will work just as well, such as Cymbalta-Effexor, or Cymbalta-Wellbutrin? Thanks for the help – I enjoy your website.
— Max
*Max clarified this was due to “side-effects mostly. I have to have blood test to make sure it’s not affecting my liver and sugar. Cost is a consideration.”
Answer: Current clinical research evidence for effective treatment of depression not responding to antidepressant alone (*see note) is strongest for the “atypicals,” including Zyprexa. There are secondary differences with each of the others. Risk of metabolic side effects and weight gain vary within the group. (Note: Assuming adequate dose and duration and preferably including a broad-spectrum antidepressant like Cymbalta or Effexor, which modulate both serotonin and norepinephrine.)
My 1st choice in this group, considering side effects and efficacy, is Abilify. (more on Abilify) Changing to Cymbalta and Abilify would be the simplest alternative. However, due to genetics and other complexities, sometimes one specific combination works better than anything else.
There’s no current solution to cost concerns (unless limited income, then see www.needydrugs.com) because no generic substitution exists for your 2 meds (2 generic drugs could be combined to somewhat duplicate the main effects of Cymbalta and another 2 for Zyprexa – but this gets tricky.).
This doesn’t mean you wouldn’t do well on Wellbutrin (available in generic), but Wellbutrin’s effects are totally different and changing would be a gamble.
Good luck!
Dr. Jones
