51 replies to this topic

[forwardlooking]

Hi, I need some advice on how to taper off quickly and appreciate any advice. About two and a half years back, I started on Duloxetine and got to 80mg in 6 months to treat depression and anxiety. However, the medicine never worked for me and has given me a lot of nasty side effects. I started the long and painful taper journey for two years already and still have about 12mg (~44 beads) to go. I did an aggressive taper initially by dropping from 80mg to 60mg in one shot. It took me down by staying in bed for one whole week. After that, I started to taper very slowly. However, no matter how slow I go (drop 1 bead in 4 weeks), I still experience many side effects (tummy pain, headache, mental and physical fatigue, hard to concentrate, etc). 

I am so desperate to get off this medicine completely. Soon, I will have an opportunity to get two months off from work. I want to take this two months window to taper off fully. I have a busy work schedule, so I need to be functional when returning to work. 

My question if this is even feasible or too aggressive even to consider this. Suppose it is possible, any suggestion on the taper schedule to make it work. Thanks so much!

[invalidusername]

Hi forwardlooking and welcome to the forum.

 

Let me start by saying you are certainly not alone in what is going on - we have had many members who have found it this difficult to drop - especially when approaching the final 10mg. 

 

"I am so desperate to get off this medicine completely"

 

That says it all and what we hear a lot of the time. But it is no good telling you to give it time as you clearly have, but just remember, this is a very small dose. I have personally been on Citalopram way longer than I need to be and have the same problem as yourself; I feel your pain.

 

Ordinarily, dropping these 44 beads over 2 months would be feasible in most cases - not easy - but possible. However in your case, I think we are going to need to find supplementation to get you through it. So my first question is - have you tried any supplements during your withdrawal? If so, what have you tried - dose, frequency?

 

From there we can start by suggesting a plan of action. It may be a situation that a cross-taper to another small dose of another drug is your ticket out, but we'll call that plan B for now as supplements should never be underrated in this respect.

 

Look forward to hearing from you.

 

IUN

[fishinghat]

Given how sensative you are to even small changes in dose I would say that dropping the 44 beads in 2 months is an unlikely recipe for success. The ebook has a lot of info on what supplements may ease the process, that is one thing to consider. I know it would be nice to finish off the Cymbalta usage but in your case pushing it may have disasterous results.

[forwardlooking]

Thanks, fishinghat and IUN, for your prompt replies. I scanned the e-book a while back. I am currently taking Vitamin B, D, fish oil, and Adrenal support supplements. It's not apparent to me whether they help or how much they help. It sounds that getting entirely off the medicine in 2 months might be too aggressive. I still aim to cut down as much as I can during those 2 months. I wonder if there is a preference between two taper approaches:

1). dropping 1 bead for a few days and keep going 

2). dropping 10% at once and stay for a few weeks?

 

Thanks very much!

[fishinghat]

That is a question I have asked myself so many times. From what I have seen either way can be a nightmare.

[invalidusername]

I'm with Hat on this one - and these things are always subjective - it will vary from person to person. 

 

Bear in mind that you are more likely to have to reinstate if you drop all at once. But I also think you would be better to be trying aids such as L-theanine or Ashwagandha along with the vitamins. Are you experiencing anxiety or depression with the taper, or is it more of the physical symptoms that are bothering you?

[forwardlooking]

Re "Are you experiencing anxiety or depression with the taper, or is it more of the physical symptoms that are bothering you?"

It is unfortunately both physical and mental symptoms. Both depression and anxiety are bad, plus the physical symptoms. Regarding Ashwagandha, is it safe to take during taper? I remembered to see some comments from a Facebook group that it is better not to take Ashwagandha while on Duloxetine.  

Also, any supplement can help with concentration? So need to get focus better to perform the daily job.

[invalidusername]

I can assure you that Ashwagandha is perfectly safe to take whilst on Cymbalta - there are select few medications that it might interact with, but SSRI and SNRI are not one of them. It worries me that such groups exist on social media who are denying people such relief. Whilst Hat and myself are not MD's, we both have extensive post-graduate backgrounds in these fields, and we NEVER state anything unless we know it to be fact. We will always find out first - if we can - and report back.

 

I'm not being paranoid, but some of these supplements could so easily take over the job of anti-depressants and the big pharma don't want you to know that, hence there will be all sorts of rumours. Unless there is a paper written about it in a respected peer-reviewed medical journal, take everything you read on the Internet with a pinch of salt. 

[invalidusername]

The best to take is KSM-66 as it is a standardised extract from the best parts of the root.

 

For the concentration I would suggest either Suntheanine or NAC. Both have been reported to help with this issue. As with all supplements, start low to ensure there aren't any side effects, but typically, one can take up to 600mg Suntheanine (maximum) and NAC is usually taken in doses of around 600mg twice daily.

[fishinghat]

I fully agree with IUN's comments. Spot on. 

 

In the case of getting rid of brain fog...many members experienced help when taking 2,000 to 3,000 mg of Omega 3. Research shows that selecting one high in epa and dha are the most beneficial. There are details in the ebook if you are interested.

[forwardlooking]

Thanks so much for the advice.  I will look into KMS-66 and NAC, and I already take Suntheanine and omega 3.  

 

Just quote what I saw from the FB group: it is not recommended to take 5htp or ashwagandha while still taking Cymbalta because they can raise serotonin levels and taken with Cymbalta puts you at risk for developing serotonin syndrome which can be fatal.

[invalidusername]

it is not recommended to take 5htp or ashwagandha while still taking Cymbalta because they can raise serotonin levels

 

5HTP - YES of course this will raise serotonin.

 

Ashwagandha - NO - if you stick to the recommended dose. 

 

I refer to the profiles taken during a recent study (September 2020), which show that ashwagandha MAINTAINS serotonin levels - does not increase - by comparison to a control group. The diagram shows 4 groups. The first, G1, is the control group which shows serotonin diminishing considerably over a period of stress, whereas the experimental groups, G2, G3, G4 show a much more stable level of serotonin - but note that it does not increase.

 

https://www.frontier...541112-g003.jpg - look at the middle of the three graphs for the serotonin.

 

Source - https://doi.org/10.3...ets.2020.541112

 

Another study shows an increase in the measures level of around 30% when taking upwards of 2mg. The graph on the following paper shows a 50mg/kg which in the average human would equate to 4500mg - more that TWICE the recommended maximum dose. So in that respect, the above statement is correct.

 

Source - https://www.research...ons-in-rats.pdf

 

Therefore in conclusion, kept within the recommended guidelines of anything up to 1.5mg - 2mg, the purpose of taking ashwagandha during withdrawal is to maintain such neurochemical levels which would otherwise fluctuate during the stress response of withdrawal. So please do not listen to these groups unless they appropriately evidence their claims.

[fishinghat]

I am a firm beleiver in erring on the side of caution but I must agree with IUN on this matter. Drs routinely give out various prescription meds that raise serotonin levels while a patient is on Cymbalta. They are just very careful in what dosage they give. A good example of this is the switch from one ssri to another. The compounds overlap on the change over but as long as the dr follows dosing guidelines then there is minimal concern. These types of concerns are exactly why we include so many medical research papers in our ebook. Medical researchers have to follow detailed research methods in their studies. Just myself, but I would not take a significant dose of 5htp while on another serotonin promoting drug/supplement.

[forwardlooking]

Really appreciate your detailed answers and all the information with sources, which is so helpful!  In terms of the dose of ashwagandha, is this one with 1000mg OK? https://www.amazon.c...0?ie=UTF8&psc=1

[fishinghat]

Most common doses range from 350 mg twice a day to 1250 mg a day. Ash  looses its effectiveness (called tolerance) after a short period of time (3 - 10 days?). After a few days off this supplement it may be taken again as its effectiveness will return.

 

The Amazon product is 500 mg twice a day and should be acceptable. The FDA has issued a warning about taking this Ash/piperine combo if the patient suffers from thyroid issues. This looks like a good product but I would defer to IUN  as he has more experience with KSM 66 products.

[invalidusername]

Hat is absolutely right in that it is good to take the occasional tolerance break (also referred to as t-breaks in social circles)... around every two weeks, take 3-5 days off ideally. That will maintain the potency.

 

The one that you have found is perfect. Black pepper potentiates the extract, but 5% withanolides is not too much to brag about. If the KSM extraction process if correctly followed it is not possible to have less than 5%

 

I'd say start with 500mg a day for a few days and then up to twice a day if you feel it necessary. I found I was taking 1000mg in the evening when I had issues sleeping. I would panic than I would not sleep. KSM really worked well for me. Chilled me right out and got me to sleep no problem. I wouldn't have taken 1000mg during the day as I was driving - not a good idea

[forwardlooking]

Thanks a ton!  Based on the information provided, I will start with 500mg per day after a meal (still need to decide morning vs. evening), and up to 1000mg, and then take a break every two weeks for 3-5 days.  

[invalidusername]

More than welcome.

 

You can take the dose after a meal, or if you find it more convenient to take it between meals, just make sure you have it with a little bit of something with fat content. As I used to take mine an hour or so before sleep, I would take it with a small glass of milk or a chocolate biscuit. 

 

Please let us know how it works for you

[forwardlooking]

Thanks very much, and you guys are so knowledgeable!  

 

I have one more question.  I am considering cross-tapering. I wonder if you are aware of any success cases to cross tapering with Wellbutrin to get duloxetine off faster.  I want to switch to Wellbutrin eventually.  

[fishinghat]

Wellbutrin cross over is inconsistant with Cymbalta withdrawal. Success is limited as Cymbalta controls serotonin and norepinephrine while Wellbutrin controls norepinephrine and dopamine. While it usually limits the symptoms of Cymbalta withdrawal it can still be a very significant issue. 

[forwardlooking]

I wonder what medicine has the most success rate to cross taper with Cymbalta?

[invalidusername]

I wonder what medicine has the most success rate to cross taper with Cymbalta?

 

Such questions will always be subjective. This is why I don't understand when people ask what is the best antidepressant. Sure you can go by reviews, but the bottom line is no information is going to help. The only way you will know is by trying.

 

Obviously, switching between different drug classes between SSRI, SNRI, MAOI, etc will have its difficulties and switching to a drug of the same class will be a smoother transaction, but if the class you were put on in the first place was not the right one, then there isn't much choice.

 

One of Hat's sayings has significance here when asking which to switch to... "you might as well flip a coin"! But that said, if there are symptoms that were not addressed by an SNRI, then it might be that you need a Dopa antagonist...

[fishinghat]

The antidepressants which members have had the most success with are Prozac, Lexapro and Zoloft, not in any particular order. That being said the drs tried 4 antidepressants on me before finding one that worked. Yes, flip a coin.

[forwardlooking]

Hi, it's been a while. I slowly dropped to 8mg by now. However, my ability to write and focus is horrible, which is a blocker for me to function. By reducing the Cymbalta, I was hoping I would gradually improve my concentration, but unfortunately, not at all. I am taking fish oil daily with the recommended dose. I wonder if I should still associate my focus issue with Cymbalta, or should I consider the root cause somewhere else?

 

Thanks a lot!

[invalidusername]

Hi - good to hear back from you...

 

You have done well to get as far as 8mg. It is the very act of reducing that will be causing the ongoing symptoms. So as you keep dropping, so will the symptoms be maintained. It is a no-win situation as you want to come off the Cymbalta. But looking positive, if this is the only symptom that is causing distress - at this point - you are doing well. As difficult as that might be to hear, and I am in no way down-playing the situation with your concentration.

 

I sincerely doubt the focus issue is elsewhere as this is a common complaint among members. Are you able to give examples that might give us a clearer indication of how this affecting your everyday life?

 

Lion's mane mushroom is something that comes immediately to mind, but I would run this past Hat first as his experience with this exceeds mine, but you may enjoy some success with this...

 

IUN

[fishinghat]

Like IUN said, you are doing very very well for sure. The brain fog is a constant concern for several months after you are fully off Cymbalta. Unluckily brain/nereve tissue is very slow to recover. I would say either NAC (N-acetylcysteine 600 mg/day) or Lion's Mane mushroom might help but I won't lie to you, it is doubtful. If you decide to go the route of Lion's Mane mushroom extract let me know last I looked there is only one product that is water extract based and may help. I can reference that product if desired.

[forwardlooking]

Thanks so much Fishinghat and IUN as you are always there to support.  I have this one at home: https://www.amazon.c...287745&sr=8-6. Is it good?  Or you suggest a different brand?

 

Regarding an example how it impacts daily life, the unability to concentrate (hard to focus more than ~3 minutes) and plus cannot structure the thoughts into writing makes professional life very challenged.  There are other physical and mental challenges but so far the focus is one of the hardest parts.

[fishinghat]

This is the one I would recommend nad have used before.

 

Amazon.com: Brain Forza Organic Lion's Mane Mushroom Capsules, Natural Support for Mental Clarity, Focus, Memory, Nerve Health, Non-GMO, Vegan, Organic, 90 Capsules: Health & Personal Care

 

The one you have is basically dried mushroom but the one above is a water extract which concentrates the effective components that you need. The ebook has details on Lion's Mane Mushrooms and their effects if you are interested.

[forwardlooking]

Thanks for the recommendation.  The product is currently out of stock.  I will keep an eye on it.  Best!

[forwardlooking]

Hi, It's been a while since the last update. I am currently at 4mg with an extremely slow taper. Currently, I am experiencing extreme chronic fatigue syndrome. I have been experiencing ongoing fatigue for years, and recently it got worse. I am not sure if it is a symptom of the withdrawal or just because of reducing the antidepressant.  Any suggestions or speculations? Thanks very much!