Dear Dr. Roach: I’ve been on Cymbalta for 16 years. I had had panic attacks, and my doctor suggested it, along with talk therapy. After a year, my therapist told me they weren’t made to be used long term and I should eventually wean myself off them. I did at one point and was good for about seven months, at which point the panic attacks came back with a vengeance. I started taking them again and am now afraid to stop. They make me feel less than worthy, in the sense that I can’t do well in life without them. I take 10 milligrams every day or five days a week as I forget occasionally. Are there long-term effects taking this drug?
D.M.
I see a great many people with conditions affecting their mind, especially depression and anxiety, and related conditions like panic attacks. This is a common occurrence, and it can affect people with any level of function. Unfortunately, there is a stigma associated with mental illness, which can keep people from getting the help that they need. I am disappointed that your therapist made what I consider an ill-considered statement.
Both talk therapy and medication are effective treatments for panic attack; however, a great many people continue to need medication long term to keep the condition under control. Just as with conditions like diabetes and high blood pressure, some people can get off medications while others need to continue them.
All medications have the risk of side effects, but for medications like duloxetine (Cymbalta), most of the side effects commonly appear when first taking the medication. Since you have been on this medication for 16 years, it is not likely that new side effects will show up now, especially at the relatively low dose you are taking. One exception may be that, as people get older, these medications are more likely to cause abnormalities of the sodium level. A periodic check of your kidney function and electrolyte levels would be prudent.
When starting a medicine, and even when having a follow-up visit to check on the medicine’s effects, the prescriber should consider the risks of taking or continuing the medicine against the risk of not being on it. In your case, with the panic attacks coming back, I think it is better to continue than to stop.
Dear Dr. Roach: My wife and I are both 88. She has dementia and now insists she will not eat vegetables. Will a vegetable-based or vegetable-and-fruit-based drink help her?
J.N.
Although a diet with many fruits and vegetables has been shown to reduce risk of developing dementia, the diet is not going to be a very effective treatment for dementia. Eating more fruits and vegetables will help both you and your wife with many other areas, especially heart disease, cancer and diabetes.
Canned fruit and vegetable juice would not be my first recommendation. Unfortunately, many of the micronutrients are lost, especially as they sit on a shelf. They are still better than soda, although many are very high in sodium. I see many people using blenders to make their own fruit and vegetable smoothies.
Many people with dementia experience changes in their sense of smell and taste that can lead to changes in their eating pattern. Many caregivers experiment with mixing up ingredients to try to find meals their loved one likes. Adding spices that increase flavour can be very helpful. Trying entirely new foods or different preparations can also encourage more healthy eating.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu
