Depression Meds post op

[priscillagreene 1]

Question for anyone who takes Trintellix or other new gen SSRI. I was taking prior to surgery stopped and thought I was good. Realized today that I need to be on them. I have so much stress at work and feel like I am a b***h all the time. I was also taking Vyvanse and want to restart it too. Any thoughts?

[coogr86 3]

Not a good idea to stop those kinds of medications without consulting your physician first. Especially the SSRI.

[Ylime 453]

Not sure anyone here is qualified to answer this question. What does your Dr say?

[AtlantaRed 651]

I asked my PCP about my anxiety meds. He said they were absorbed lower in the intestines and that only the Vitamins are to worry about.

[KRush88 105]

On 07/09/2018 at 19:28, priscillagreene said:

Question for anyone who takes Trintellix or other new gen SSRI. I was taking prior to surgery stopped and thought I was good. Realized today that I need to be on them. I have so much stress at work and feel like I am a b***h all the time. I was also taking Vyvanse and want to restart it too. Any thoughts?

I'm currently on an antidepressant and Adderall after surgery I will continue to take them doctors orders. I was told to get pills that are able to be crushed. I will not stop those meds being that they make me feel completely sane

[CyclicalLoser 155]

I'm still tweaking my dose, but the bottom of the line, you want to find out where the meds are absorbed, and then you want to find out if there is a sublingual or patch you can take.

I take Luvox and Lamictal. The Luvox seems to be okay, and my research did not indicate absorption issues with RNY patients. The Lamictal is mostly metabolized in the stomach, which we basically don't have. Another person on the board told me that it was available as a sublingual, and after meeting with my psychiatrist, I am now a few days in with the sublingual and the discontinuation symptoms have went away and I generally feel better.

If they are capsules, you might be able to mix them in with food. You also might be able to take a smaller dose several times a day. If they are "extended dose" meds, then I think you should switch to the standard form.

At the end of the day though, I think you need to be prepared to experiment (Of course at your doctor's permission) to find the right combination.

I wish you the best!

[insta_adventurer 1,046]

I was on cymbalta and Wellbutrin xl... and they switched me to celexa and non-xl version of Wellbutrin.

My surgeon advised that the only issue was extended release meds. My primary said everything had to be tablet and crushable.
My psychiatric NP said we’d have to wait and see if I needed to change. It was frustrating- all those different answers. I ended up following my surgeon’s recommendation.

So far- no issues other than I get full from my morning medications. Had really strong anxiety around surgery tome, but I think that was due to switching from cymbalta to celexa.

[Born in Missouri 1,264]

15 hours ago, CyclicalLoser said:

I'm still tweaking my dose, but the bottom of the line, you want to find out where the meds are absorbed, and then you want to find out if there is a sublingual or patch you can take.

I take Luvox and Lamictal. The Luvox seems to be okay, and my research did not indicate absorption issues with RNY patients. The Lamictal is mostly metabolized in the stomach, which we basically don't have. Another person on the board told me that it was available as a sublingual, and after meeting with my psychiatrist, I am now a few days in with the sublingual and the discontinuation symptoms have went away and I generally feel better.

If they are capsules, you might be able to mix them in with food. You also might be able to take a smaller dose several times a day. If they are "extended dose" meds, then I think you should switch to the standard form.

At the end of the day though, I think you need to be prepared to experiment (Of course at your doctor's permission) to find the right combination.

I wish you the best!

I'm that other person on the board who told you that lamotrigine is available sublingually. I'm glad that I was able to help.

[CyclicalLoser 155]

44 minutes ago, Missouri-Lee's Summit said:

I'm that other person on the board who told you that lamotrigine is available sublingually. I'm glad that I was able to help.

Gracias and Danke Sehr for that by the way. So far 100mg of morning ODT is working much better. It doesn't taste like I'm crunching dishwasher detergent pellets and the discontinuation symptoms have completely went away.

Thank you again. Interestingly, my Psychiatrist said that it came out first as ODT and that in general ODT is the "purest" way to get absorption into one's system.

[jaksmommy 8]

This is an interesting discussion. I take Cymbalta, Lamictal, and Lexapro. There is almost no information about psych meds after RNY. My surgeon said I “should be fine.” My psychiatrist said we can “reevaluate after surgery.” In the meantime I am 6 days post-op RNY, hiatal hernia repair, 50% removal of my stomach, and I don’t know if I am still fuzzy headed and nauseous because of dehydration or med withdrawal. I feel like I made a horrible mistake that I can’t take back. Should I crush, take whole, open the Cymbalta capsule?? Would a pharmacist have a better idea about absorption?

[insta_adventurer 1,046]

On 08/02/2018 at 19:46, jaksmommy said:

This is an interesting discussion. I take Cymbalta, Lamictal, and Lexapro. There is almost no information about psych meds after RNY. My surgeon said I “should be fine.” My psychiatrist said we can “reevaluate after surgery.” In the meantime I am 6 days post-op RNY, hiatal hernia repair, 50% removal of my stomach, and I don’t know if I am still fuzzy headed and nauseous because of dehydration or med withdrawal. I feel like I made a horrible mistake that I can’t take back. Should I crush, take whole, open the Cymbalta capsule?? Would a pharmacist have a better idea about absorption?

You cannot crush cymbalta. It’s extended release. I’ve heard of people opening them and using the little beads to ween themselves off of it.

Are you unable to swallow it? They had me swallow tablets very soon after surgery. I understand your frustration and wasn’t given clear answers about how to handle. I will say that switching to non-xr Wellbutrin and going from cymbalta to celexa has had no negative impacts on me. However- psych meds really depend on the person and what works for one may not work for another.

[CyclicalLoser 155]

Cymbalta is a SNRI's, of which I've only taken Effexor. Being that it is in capsule form, I would think that you could open the capsule and consume the "beads". If it is an extended release, perhaps there is a standard release version. Otherwise, you might be able to either increase your dose, assuming a certain percentage lost due to malabsorption, or take a smaller dose at multiple times of the day. See my posts above for lamotrigine/lamictal because that has really helped me.

If I remember correctly, lexapro/Escitalopram was a small tablet (I took it for years a while back). If the small tablet isn't an extended release (I don't recall there being such a thing when I took it), then you should be able to crush the tablets, even though it will probably taste awful. What is strange to me is that your Serotonin receptors are getting hit pretty hard twice as Cymbalta and Lexapro affect it. While I'm far from a doctor, but maybe you could avoid cymbalta and instead take a larger does of Lexapro and a NRI (Such as wellbutrin) separately. This might help with the dosing.

Your psychiatrist or pharmacologist is probably going to know the most, however I doubt most of them specialize in treating people post RNY. I would do some of your own research on the absorption issues based on peer-reviewed medical journals. To make it easy, include "NIH" in your googling as the National Institute of Health usually pays for, or is affiliated with the research -- That's where I found info about Lamictal needing the stomach to absorb the meds (Until Missouri-Lee's Summit found the sublingual version).

I hope you can get them figured out!

[bnic2002 5]

I take cymbalta and had surgery on the 1st
Dr said wait 4 days then I can take capsule again. I am in pain and not working so dont kow about withdrawal. I usually get zaps if I miss a day. Have not had it in 3 days

[MissPoodle 58]

No one can predict how we go with drug absorption post surgery. As you have said there isn't a lot of research. What I've researched says that if you are allowed to crush the tablets than do so...and not to stop them. If you are on extended release medication then your psychiatrist needs to have a plan for you personally on how to manage that particular medication. Some people are switched to an alternative non sustained release med. Either way, anyone on medication needs close monitoring by their doctor.

Sent from my SM-G950F using BariatricPal mobile app

[jaksmommy 8]

Thanks to everyone that replied. The worst thing I have ever gone through was the sudden need for psychiatric meds 10 years ago. I would rather have a broken bone than go through the 2 or 3 weeks it took to find a combination of drugs that worked. I will talk to my psychologist about a possible replacement for cymbalta and ask about the siblingual Lamotrogine. I really appreciate the help.