114 replies to this topic

[viola639]

@fishinghat, then Citron it is . My heart is just beating out of my chest today. How does every anxiety symptom occur near ur chest or ur stomach ? 

[fishinghat]

Your heart and your stomach are both controlled by the vagus nerve and that nerve contains a very high amount of adrenaline receptors. Sucks doesn't it?  lol

[viola639]

Ah calming the vagus nerve seems to be my best bet. 

[fishinghat]

Ahh, and that is the rub. To calm the vagus nerve you would also calm the heart which in turn lowers blood pressure. Clonidine is one of the most effective drugs in reducing the effect of adrenaline, the main cause of anxiety but that will reduce bp.

 

Viola, I would like to ask you a favor. I have no data in the ebook on how many beads in the capsules of Torrent duloxetine, can you you fill in that gap?

[viola639]

Sure fishinghat, i'll get more info on the beads once i get them . Right now i'm dealing only with the side effects of cymbalta, so i wont move until i settle. 

Clonidine maybe 1/4th of a tablet might be my best bet. 

 

Do you think there is anything that can help with the stomach symptoms, i'm losing weight due to the excessive diarrhea . 

[fishinghat]

Thanks Viola

 

I think that a 1/4 tablet should be OK. It takes about 1 hour to kick in so you might check your bp about 1 to 2 hours after taking the clonidine just to be sure all is OK

 

Most members had good luck with a 1/4 to 1/2 tablet of Imodium AD every day. Just start out easy until you find what dose works best for you. Also, taking fiber can help a lot. There are two schools of thought. Soluble fiber to absorb excess water and insoluble to bulk up the digestive tract. A word of warning, it has been my experience that for anyone person only one type of fiber will work and the wrong type will make gas and stomach cramps. For me it has  been insoluble fiber (wheat bran) that works but for others it is the soluble fiber (psyllium).

[viola639]

@fishinghat, thank you so much. I'm going to get imodium AD immediately and try wheat bran for fiber (psyllium gave me the runs ). Also what is your opinion on CBT and hypnotherapy? I plan to tackle this heads on, because if i'm planning to get pregnant, i can't afford to have breathing issues . 

[fishinghat]

IUN is our recent CBT expert so I am sure he will respond to that question. Al I know is there is a lot of variability between strains and preparation methods and it is essential to find a medical marijuana dealer that is very knowledgeable. 

 

I am not deeply familiar with hypnotherapy but have heard that its success is strongly tied to the education and experience of the provider as well as the "acceptance' philosophy of the patience. Much has been written on both the good and the bad of this technique. 

[viola639]

Thank you @fishinghat , i was talking about cognitive behaviour therapy (CBT), not CBD (any kind of weed scares me ). Yes, i'm hoping hypnotherapy helps a bit. It is basically my mom's student (who is a hynotherapist). She herself is one, but she feels i might benefit from someone who is not family, so i take it seriously. 

 

Also l-theanine safe to take alongside cymbalta ? About 100mg once/twice a day apart from cymbalta? 

[frog]

Hi again Viola,

Catching up on your thread. It sounds like you're dealing with many of the same side effects that I had after I got off Cymbalta: I had nonstop panic attacks, urgent diarrhea that just got worse and worse over time, trouble breathing, and I also got insomnia on top of it. 

 

Want to echo some of what has already been said here: for the diarrhea I've been taking Citrucel fiber in the AM and PM, but what helped the most was taking Imodium AD daily. I think I started with a full pill every day and then over time decreased it as I began to feel constipated until I was able to come off of it completely a few weeks ago. I only take fiber now and the diarrhea seems to be at bay . I can just about eat whatever I used to now without issues though I am still constantly on high alert looking for signs of stomach trouble. I wish I could relax and not worry about it anymore

 

Panic attacks eventually went away on their own after many months. I had been taking Propranolol to help deal with them. I've not tried clonidine so I can't speak to it. Propranolol also lowers your BP. 

 

Once the panic attacks subsided I was left with a lot of constant trouble breathing. All day long I felt like I couldn't catch my breath. Of course trouble breathing triggers a stress response in your body so it's sort of a vicious cycle. L Theanine helped me TREMENDOUSLY. It lowered my level of anxiety which has significantly decreased the breathing issues. Or maybe vice versa? Chicken or the egg I guess... I take 100mg in the AM and PM every single day. I haven't had any side effects. I've been really really tired the past couple months but I honestly can't say that that was from l-theanine. 

 

I still feel sort a low level present anxiety and I still have to take medication to fall asleep every night, but I feel so much more normal now. I'm optimistic that the anxiety will get better once COVID goes away too. At this point it's just impossible to say where the anxiety is coming from. 

 

As far as CBT, this is just my personal opinion I'm obviously not a professional so take it as that, but I don't think CBT is going to do much for you right now because your issues are not in your control. These are not behavioral patterns, these are chemical reactions in your brain. The CBT will probably come more in handy after it's all over. With that said, I do definitely recommend finding yourself a therapist that you feel safe and comfortable talking to, because these withdrawals are no joke and it can feel VERY isolating going through something like this when it seems like no one else can understand or relate. It's great to be able to unload on someone other than your loved ones

[viola639]

@frog thank you so much <3, this is what i needed to hear. All these experiences that i'm having is making me mad, i question my sanity a lot of times. 

 

Also, have you taken L-theanine along with cymbalta, i have not tapered yet, but i reinstated, so i don't know if l-theanine is the right supplement to take .

 

I do feel great on taking earl grey tea, so it has l-theanine, so i assume that is the reason for feeling better. 

[frog]

Could be though green tea is supposed to have a lot more l-theanine than black so you could try that

I was not on Cymbalta when I started L-theanine. I wouldn't think there would be any interaction between the two, but the reality is that I doubt this has been studied. You've been drinking tea while on Cymbalta without issues though so i think you'll be fine. 

 

Hang in there!

[fishinghat]

Hi Viola. 

 

Good info from frog, as usual.

 

Taking up to 100 mg L-theanine with an antidepressant, including Cymbalta, is acceptable. Usually members use 100 mg once or twice a day.

 

Sorry about the CBT misunderstanding. I will blame it on Cymbalta.  lol

 

Yes CBT  is great at teaching some wonderful stress coping tools but some of them can take some time to master. Like frog said, it may be a big help after the withdrawal although there will be some help during withdrawal. 

 

Be sure your tea doesn't contain sugar or caffeine as that can make things worse.

[viola639]

@fishinghat @frog, i don't know how long this ocd is going to be there (12 days going on now). I'm maintaining still at my full dose with the old cymbalta brand. I still can't believe a brand change could cause days of panic like this . 

 

Any advice on this constant cycle of thinking about breath and panicking ?, how do u cope ?, when will this stop , i'm going mad with stress. 

[fishinghat]

Returning to the original brand usually sees a return to normal in a week or so but I have seen it where it seems like it will not stabilize at all. Lets hope for the best in your case. Unluckily it is not unusual for things to get out of whack when changing brands and changing back to the original brand makes the transition take even longer in some cases. I wish I could tell you when it will get better but it varies so much all I can do is reflect on what members have said in the past. At this point have you tried any supplements?

[viola639]

Yes fishinghat, i have no clue what's happening . I'm just really sad, i'm also losing weight and have been spotting for the past 5 days. It could all be adding to the stress. I'm thinking of try l-theanine, but worried it might cause serotonin syndrome. A group on facebook, says it could cause that with cymbalta. 

Also i'm losing weight, could this be releasing cymbalta from my fat stores and causing me to unstable ? I don't know. 

Is this just cymbalta stopped working for me and it is time to move on a new medicine ? I don't know, i'm just scared now. 

[fishinghat]

L-theanine is an amino acid precursor to glutamate (involved in the synthesis of GABA) and glutamine. It can cross the blood brain barrier. It is only produced by plants and fungi and a component in some teas. It inhibits glutamine transporters and glutamate transporters, and thus blocks the reuptake of glutamine and glutamate. Theanine increases serotonin, dopamine, GABA, and glycine levels in various areas of the brain. Caution – Most plants that contain L-theanine also contain caffeine and it can be a significant contaminant in L-theanine supplements. It is synthesized from glutamate using the enzyme glutamate decarboxylase and pyridoxal phosphate (which is the active form of vitamin B6) as a cofactor. This process converts glutamate, the principal excitatory neurotransmitter, into the principal inhibitory neurotransmitter (GABA).

http://en.wikipedia.org/wiki/Theanine

 

So yes, it can increase serotonin levels. Yu might try NAC )N-Acetyl Cysteine. It is an antioxidant and neurotransmitter stabilizer.

 

 

NAC - N-acetylcysteine - Strong antioxidant.

https://www.ncbi.nlm...pubmed/18534556

NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder.

https://www.ncbi.nlm...pubmed/25004186

the study provides only limited support for the role of NAC as a novel adjunctive therapy for MDD. 

https://www.ncbi.nlm...pubmed/21719110

These open label data demonstrate a robust decrement in depression scores with NAC treatment

https://www.ncbi.nlm...pubmed/22891797

There were no significant between-group differences in recurrence or symptomatic outcomes during the maintenance phase of the trial;

https://www.ncbi.nlm...pubmed/27725170

The anxiolytic effects of NAC were comparable to diazepam. 

 

https://www.research...stematic_review

https://www.ncbi.nlm...pubmed/29045497

modulation of Glu transporter expression may restore Glu (Glutamate) homeostasis.

 

https://www.ncbi.nlm...pubmed/24676047

These studies evaluated the role of NAC (N-acetylcysteine) in cocaine dependence (three studies), c******* dependence (two studies), nicotine dependence (two studies), methamphetamine addiction (one study), and pathological gambling (one study). Five of these trials were double-blind, randomized, and placebo-controlled.

The studies analyzed suggest a potential role for NAC in the treatment of addiction, especially of cocaine and c******* dependence. These results are concordant with the hypothesis of the involvement of glutamatergic pathways in the pathophysiology of addiction.

 

https://www.ncbi.nlm...pubmed/27179791

Furthermore, NAC was able to rescue changes in key glutamate receptor proteins related to excitotoxicity in HD, including NMDAR2B. Thus, we have shown that baseline reductions in cysteine underlie glutamatergic dysfunction and depressive-like behavior in HD and these changes can be rescued by treatment with NAC. These findings have implications for the development of new therapeutic approaches for depressive disorders.

 

https://www.ncbi.nlm...pubmed/18534556

NAC appears a safe and effective augmentation strategy for depressive symptoms in bipolar disorder.

 

https://www.ncbi.nlm...pubmed/25004186

the study provides only limited support for the role of NAC as a novel adjunctive therapy for MDD.

 

https://www.ncbi.nlm...pubmed/21719110

These open label data demonstrate a robust decrement in depression scores with NAC treatment

 

https://www.ncbi.nlm...pubmed/22891797

There were no significant between-group differences in recurrence or symptomatic outcomes during the maintenance phase of the trial;

 

https://www.ncbi.nlm...pubmed/27725170

The anxiolytic effects of NAC were comparable to diazepam. 

 

https://www.scienced...278584613000420

https://www.ncbi.nlm...antidepressants

Interactive effects of N-acetylcysteine and antidepressants

https://www.research...sistant_Anxiety

 

[fishinghat]

I am concerned about your spotting the last 5 days. Cymbalta can cause a loss of estrogen and testosterone production. Is this out of your cycle schedule or is it to be expected at this time?

 

If you are loosing weight it most certainly can be causing Cymbalta to be released from your fat tissue and make stabilization more difficult.

 

I would suggest you give it a few more days and if things do not improve then talk to your dr about doing a cross-over to Zoloft, Lexapro or maybe Prozac. Unluckily there will still be issues during the cross over until the new antidepressant kicks in (4 to 8 weeks depending on the antidepressant.

 

By the way N-Acetyl Cysteine stabilizes glutamate production and thus stabilizes neurotransmitter action. It will not cure your symptoms but it may take some of the edge off.

[viola639]

Thank you fishinghat, that is really thorough information , i really appreciate all the help you are giving. I don't know where i would be without you. I'll get NAC at 600mg, that seems to be the therapeutic dose 

 

Also maybe can i try a small dose of 100mg L-theanine, i think even a small dose might give me relief. 

My cycle is delayed by 15 days and is extremely spotty for the past  days. That scares me a lot. I'll get in touch with my psychiatrist and see what he says about changing to zoloft/lexapro/prozac.

 

i have been on cymbalta for 15+ years, do you think bridging to zoloft/lexapro will take time ?, will there be symptoms ?

[fishinghat]

Crossing over to the other antidepressant will take a few weeks and during that time you will typically the same symptoms as currently or even worse. Remember that Cymbalta regulates serotonin and norepinephrine but an ssri controls only serotonin so even with the change over you may still suffer from anxiety until you settle down which can still take a lot of time. No easy choices.

[frog]

Ugh I'm sorry to hear Viola. 

The breathing is a huge issue and it unfortunately creates a cycle like you said. Being really stressed out can tighten the muscles that help you breathe (literally will feel like your chest is super tight) and that causes really shallow breathing, and as if that's not enough, once you start feeling like your breathing is more labored you naturally start to panic about it and then you're stuck in a loop. The stress might be from outside factors or it could be stress caused by the withdrawal, or a combination. Hard to say really. 

 

So your best bet is to reduce the stress or reduce your body's response to the stress. Easier said than done. As FH suggested, you can try some supplements like l-theanine or prescriptions that have been mentioned. You can also do some breathing techniques that are intended to signal to your brain/body that you are relaxed. Like breathing in through your nose and then slower through your lips. There's also diaphragmatic breathing. And you can try progressive muscle relaxation. All designed to signal to your body to lower the stress response. 

 

My breathing was so labored at one point that I constantly felt really anxious and panicked about it. L-theanine helped take everything down to a much more manageable point. But still I notice that I am constantly tense and holding my breath and have to remind myself to breathe out and relax. There's definitely still an underlying persistent level of stress that's keeping me tensed up. When something actually stressful occurs it escalates my anxiety very quickly as a result. I plan to try progressive muscle relaxation techniques again to see if that helps

[viola639]

Thank you fishinghat and frog , that really helps. I just hope the shortness of breath is because of acidity and not something permanent (anxiety has triggered acid reflux many times, just not this bad). 

 

I'm just worried about missing the norepinephrine component . I'll try my best to bridge properly. Do you both know of a proper bridging strategy to avoid issues ? 

[fishinghat]

There are two theories on this. Some drs believe that one should stop their current antidepressant cold turkey and start the new AD at near full dose. This avoids a possibility of serotonin system but can cause a lot of issues until the new AD kicks in. The second school of thought is to slowly wean off the current AD over a 4 or 5 week period while slowly going on the new AD at the same time. 

 

The ebook contains considerable information on 'cross-tapering' recommendations from various medical research and government agencies.

[viola639]

Ah thank you fishinghat, those two thought patterns make sense. Do you think the slower 4-5 week period makes sense, i feel that might help avoid withdrawals/or atleast some. 

 

Also, i see that i'll miss norepinephrine regulation, when i switch to ssri, what are some of the side effects of adjusting to that. Are Panic attacks/vagus nerve control under this one ?

[fishinghat]

It has always seemed to me that members have more success doing the 4 to 5 week change over but that is just my observation. There is a very slight chance of serotonin syndrome but if it occurs you will notice a fever and can address the issue right away. I would recommend that you discuss this with your pdoc.  I would also say that changing to a different AD can be a big step in the right direction or a bad experience if the new AD doesn't work for you. Myself and others have had to switch to 3,4 or 5 different ADs before finding one that worked. During this withdrawal symptoms run amok. No easy choices.

 

The lack of control of norepinephrine is indeed a vagus nerve issue as well as an emotional issue. Symptoms can typically include heart pounding, nervousness, chest tightness, shaking, increase in blood pressure and of course significant anxiety. Many drs would want to prescribe a benzo for these symptoms which can be beneficial but there are some serious downside to this which we can discuss when the time comes.

[viola639]

Thank you for your response fishinghat and frog , i had an appointment with my doctor and will have one tomorrow. Today he suggested maybe shifting to brand name cymbalta and see if it helps, he is otherwise ready to shift me to lexapro. 

 

What do you think, i greatly value your opinion, i actually told him i would talk to him tomorrow after discussing. 

[fishinghat]

Well just my humble opinion but it has seemed to me that original Cymbalta "Eli Lilley) Has a more consistent bead count and the right number of beads.  Also Lexapro, Zoloft and Prozac are the ssris that appear to have the most benefit to Cymbalta withdrawal so I would be good with Lexapro. A quick question...are you over 60 with a history of irregular heart rhythm?

[viola639]

Thank you fishinghat , do you mean going on the original cymbalta might be better instead of switching to Lexapro ? 

Oh i'm 30, no history of irregular heart beat and was put on this drug during my teens , i don't know what my parents were thinking. Now fast forward 15 years, it is really hard to ween or even imagine another self of me. That is the post scariest part. 

[fishinghat]

Going to original Cymbalta still may not stabilize you but it is hard to be sure.

 

Lexapro is an ssri that has been used successfully by many members to help with Cymbalta withdrawal but you will still have some anxiety6 issues if you switch from Cymbalta to the Lexapro because of the norepinephrine.

 

Just my personal opinion but I think the Lexapro would be the best bet in the long run. If anxiety does become an issue there are drugs and supplements that may help that don't have withdrawals. Once stable, if you want, you can then taper off the Lexapro. 

[viola639]

Thank you fishinghat, that really helps, i'll talk to him about this. I really appreciate your help in this.