41 replies to this topic

[invalidusername]

Yes Son - you are spot on. The best way to withdraw is to do so with as close to steady stream of cymbalta in your system. To put it in a mathematical formulae;

 

1 + 2 beads - taking 1 bead at 8am and 2 at 8pm - note that it take 3 hours to reach max serum level

11am - 225% (100% from 1 bead morning dose, 25% left from previous morning 1 bead, 100% from previous evening dose)

11pm - 300% (50% left from morning dose 1 bead, 50% from previous evening 2 bead, 200% from evening dose)

 

Sorry if the math is a bit confusing, but you can see that you will have a spike in the evening, which will reduce every morning and induce a mini withdrawal of its own

 

1 + 1 + 1 beads - taking 1 bead at 8am, then 4pm, then 12am

11am - 238% (100% from latest dose, 67% left from 3am dose, 46% left from 7pm dose  25% left from yesterdays 11am dose) 

7pm - 238% (100% from latest dose, 67% left from 11am dose, 46% left from 3am dose  25% left from yesterdays 7pm dose)

3am - 238% (100% from latest dose, 67% left from 7pm dose, 46% left from11am dose  25% left from yesterdays 3am dose)

 

So evenly spaced beads will give you a steady level of serum throughout the day. You won't have the massive 75% drop in doses (which constitutes a third of the dose) which believe me can make all the difference. So odd doses can be dealt with this way which will help maintain the serum levels and alleviate the associated issues.

 

Hope that gives you a suitable picture....

 

IUN

 

p.s. Hat - feel free to check my math!!

[SonSetFree]

Hey IUN,

 

Thanks for the analysis.  The math makes sense to me.  

 

Hey Hat,

 

What do you think about IUN's recommendation?  Should I up dose 1 bead in my morning dose to balance to 2 beads AM and 2 beads PM?  I was at 4 beads once a day when I cold turkeyed last July (along with 75 Wellbutrin).  I have dark crippling fear and depression, crying spells, dizziness, etc.  The one downside to increasing Cymbalta is if I have a bad interaction happening with the introduction of Remeron.

 

As always, thanks for your advice IUN and Hat,

Son

[fishinghat]

Hi SSF

 

I have no problem with the one bead increase in the morning. This increase should not produce a significant reaction with the Remeron at such a low dose. Keep up the good fight. You can make it.

[SonSetFree]

Thanks Hat, IUN,

 

I did start the extra bead on the 11th so I am about a week in.  Nothing major to report, no improvement yet and some symptoms worsening some.  I do want to bounce something off of you guys.  I need to know if what I am experiencing is normal because I am absolutely terrified. I am experiencing a type of fear that is indescribable. Strange, odd random things are freaking me out. The other day I was watching a cardinal out the window and all the bird did was tilt his head in a certain direction and it FREAKED me out to the point where I wanted to scream. A few weeks ago I was talking with someone and noticed the whites of their eyes and it totally freaked me out. A random woman smiled at me today and it creeped me out. It’s like the anxiety and fear are so severe that it’s producing this altered perception of reality. What on planet earth is this and why am I experiencing this at a time when things should be improving? This started happening around the 7 month mark and has gradually been getting worse since. I’ve had depersonalization/derealization. And this goes far beyond that.

There is no possible way to relay the severity of the fear in an email.
Fishing hat, I remember reading that you suffered from intense unrelenting fear for months and if I remember correctly, it didn’t subside until you got on Zoloft.
Is that what I need to look at doing at this point?? It has been over eight months and while some of the physical symptoms have become less intense, there has been zero improvement psychologically and it has actually gotten worse. At the five month mark, I began clinging to the 9 month mark thinking “ok, I can do this for four more months”. And that is the only thing that kept me going. I am now almost at the 9 month mark and there seems to be no end in sight with symptoms getting worse. I am at a complete loss and don’t know what to do. All I know is I don’t have much more in me…. I need some hope.

 

Appreciate you too tremendously.  

[fishinghat]

I am not surprised by the fear symptoms. Goodness knows that is an awful experience. With that type of fear it is very difficult to "wait" until things are better. Just my opinion but I would say you have two choices...go up another bead or two or go on something else. The ssri which seem to work best for members is Zoloft, Lexapro or Prozac. I wish I could help more.

[SonSetFree]

Thanks for your response Hat,

 

Any theories or logic on why going on an SSRI would be more beneficial than working back to a therapeutic dose of Cymbalta?  

 

Also, I have to consider my drug cocktail.  As a reminder, I am taking;

 

7.5 mg Remeron and 50 mg Trazodone at night to sleep

21mg Wellbutrin divided in 3 doses and 4 beads Cymbalta divided in 2 doses

 

If I try going on an SSRI, I would need to drop a med or two.  Which would you drop?

 

Thanks Hat, hope all is well with you.

 

-Son

[fishinghat]

Cymbalta is a snri so it controls serotonin and norepinephrine while a ssri controls only serotonin. This usually means it is easier to withdraw from a ssri. 

 

I would start with the Cymbalta once the ssri kicks in. After that I would do either the Remeron or the Trazadone. You might ask your dr what he thinks.

 

Are you not feeling any improvements lately?

[SonSetFree]

Sleep improved some and I had a brief window.  Then it all came back.  

 

I may try going up another bead or two before trying the SSRI route.  I assume there are risks going on full SSRI.  You mentioned 50% or so success rate, what about the other 50%?  Did it make things worse or just stay the same?    Any long term repercussions?

[fishinghat]

The biggest risk going on a ssri is that only about 50% of the time do members see any benefit. Usually if there is no benefit it doesn't make withdrawal worse although side effects may increase. All long-term use of antidepressants carries risks. Liver or kidney damage, sexual side effects, and much more.

[fishinghat]

You can go to this website and type in the name of the medicine and the full drug insert will be shown and you can see nearly all the possible effects of taking any prescription drug.

 

DailyMed (nih.gov)

[SonSetFree]

Ok thanks. What about the withdrawal itself, would taking the SSRI risk further damage causing withdrawal to be worse long term?

 

I have been on an SSRI many years ago and did ok.  What dose would you start on?  The lowest prescribed dose?  Half that?

 

Also, I have Wellbutrin Withdrawal possibly in the mix.  I went off Wellbutrin at 75mg and reinstated at 22mg.  I could try updosing 10-20mg, which would also increase the Cymbalta via the metabolism effect, and see if that helps.  Any thoughts on that?

[fishinghat]

Ssri withdrawal is like snri withdrawal in that it is an individual thing. Just my own thought on the matter (not based on any scientific information) I have always thought that staying with the one withdrawal (in your case Cymbalta) is better than seeking relief by using another drug which not only has its own withdrawal but also the risk of new side effects or drug interactions BUT this means the use of excessive patience. It may take you months more to stabilize from what you have already been through. The decision to go to a ssri for relief is one that only you can make. Just how debilitating is your current symptoms? Can they be tolerated until stable? Obviously, that depends on the amount of suffering you are going through, effects on relationships and your job. 

 

As far as what dose to start on...Well first of all I would recommend either using Prozac, Zoloft or Lexapro to get relief. These three seem to have the best tract record for helping with Cymbalta withdrawal. When I did my switch to Zoloft my dr and I were determined to use the minimum amount in order to have success. He started me on 25 mg for 6 weeks (it takes this long for it to fully kick in). Every 6 weeks to raise the dose by 25 mg until I am comfortable. Maximum dose of Zoloft is 200 mg and I stabilized nicely at 125 mg. I tried 3 or 4 other antidepressants before find that the Zoloft helped. 

 

You could try the updose on the Wellbutrin but updosing of antidepressants seems to be hit and miss when trying to get relief. 

 

There are no clear-cut answers here. Drs have been trying to answer these same questions you have for years but there is just too much variability in how people respond. Sorry