Dear Kim, Cymbalta isn't especially notorious for causing weight gain, though it can happen. If you just stopped Remeron (which is more known for weight gain) it might make sense to give that change enough time to tell if it's made a difference before adding more variables to the equation (ie, stopping another existing medicine). One would also want to be sure that your insomnia isn't the result of a medicine (eg, Cymbalta?) and that anything you're taking that can have a stimulating effect is taken in the morning. Insomnia, like depression, is a symptom that requires a diagnosis, rather than just imposing medicines to induce drowsiness. Insomnia can arise from depression, restles legs syndrome or other periodic limb movement disorders, sleep apnea, poor sleep hygiene, a circadian rhythm disorder, alcohol or other drug effects, to name a few. I'd think it would be a useful first step to get your doctor's impression of the cause for your insomnia, decide if you should have a sleep study, and then treat the diagnosis of what's causing the insomnia -- the right medicine for which would heavily depend on the diagnosis.
Certainly you'd want to discuss decisions about stopping or starting medicines with your doctor to get their advice and recommendations as well as discussing risks (eg, relapse) and alternatives. Weight gain from psychiatric medicines can result from many factors and can be hard to lose even after stopping a suspected offending agent. That said, Remeron and Cymbalta can be a potent antidepressant pairing so you'd want your doctor's input on how efficacious that particular combination has been for you before dismantling it.
There are many medicines thought to be more weight-neutral than Remeron (and other antihistamines), as well as a handful of medicines sometimes used to counteract weight gain -- enough info to fill a book, actually, so I would advise a thorough discussion with your doctor on this complex dilemma, which unfortunately likely has no simple answer.
Dr GView Thread
Dear Renee, 8 mg/day of risperidone is a pretty substantial dose. If a patient of mine were taking that dose I would mainly be watchful for restlessness (akathisia), muscle stiffness, and the effects of high prolactin levels (i.e., fluid secretion from nipples, irregular menses). Dr. G.View Thread
The biggest problem with antidepressants for bipolar depression isn't their risk to cause mania -- that's fairly rare -- but rather, that no one has ever shown that they work for depression better than a placebo in bipolar depression (unlike unipolar).
Dr GView Thread
Dear Renee, If you ask your doctor to do a medline search on clozapine and treatment resistant bipolar disorder, he'll find the published medical literature describing its use for that purpose. Weight gain can be a formidable side effect but if the benefit is substantial and other things haven't worked, it may be worth considering (and side effects, including weight gain, can be managed....for an extensive discussion, see my book on managing psychotropic drug side effects published by American Psychiatric Publishing...on Amazon).
In the manufacturer's original studies with Cymbalta for unipolar depression, weight changes varied from zero to up to about 5 pounds over the course of 1 year. In real-life experience, and from my own impression, yes, Cymbalta can sometimes cause more weight gain that those numbers would suggest.
Dear Renee, Watchful waiting sometimes makes sense if symptoms are low severity, or there's an impression that they may be mild and transient, but if someone is having many episodes of either polarity, regardless of the polarity, then there's a compelling argument to be made for using combinations of mood stabilizers not only as a strategy to potentially treat today's depression but even more importantly to minimize the risk of future episodes, of either polarity.
Prozac alone would be dicey in bipolar I disorder given its potential to induce mania if given alone. Latuda is the only weight-neutral drug that's established to treat bipolar depression, plus it's also an antipsychotic.
Dr GView Thread