9 replies to this topic

[LeftFoot]

Seeking advice on next steps to take!

I was prescribed 60 mg. Cymbalta for chronic & severe cervical nerve pain ~7 years ago by my Pain Management doctor, following disc surgery.

Decided to stop, to see if it was the cause of my insomnia (it was.)

Did the "bead count" taper, starting in late October, and ending on Jan. 24th (so ~3 month taper.) Reduced by 5 beads every 3 days. I tapered down to what was probably 15-20 mg. and stopped the drug then.

Had the usual brain zaps for a bit but not too many other symptoms.

In mid April I started becoming depressed (chalked it up to S.A.D. due to our crappy weather.)

By mid May, depression is severe, and I have also developed significant anxiety, which is new to me. 

 

So I'm left with several questions:

 

1.) I felt OK for the first 3 months off the drug, but symptomatic after four. Is that unusual?

2.) did I taper off too fast (is 3 months too fast for a 60 mg. dose?)

3.) If the taper was too fast, should I restart the drug at 20 mg. and restart the taper?

 

The other scenario is that I developed depression and anxiety over the past 7 years and Cymbalta was successfully handling that, so I didn't have symptoms.

I have scheduled an appointment with a psychiatrist for mid-July, as my PM doctor isn't equipped to answer these questions.  

 

So I need to pick a path: stay off the drug? Restart the taper? Go back on the Cymbalta (maybe a lower dose would reduce the insomnia?)

 

Thanks for reading, and Thanks in advance for any insight you can provide!

 

 

[fishinghat]

Welcome leftfoot.

 

Question #1

Unusual but has happened to several of our members.

 

Question #2

In my experience I would say too fast. I usually recommend a 1 yr or longer wean. The cold turkey drop from 20 mg is a definite bad idea. These kinds of drops usually give people a severe withdrawal experience which can last months and up to a year.

 

Question #3

At this stage I would not recommend reinstating the Cymbalta. We have found that reinstating is only about 50% successful and if it doesn't work then you have to go through more withdrawal as you come off that 20 mg. 

 

I would suggest that you take some time to read through our free ebook which summarizes what members have tried and how it worked out, medical research, diet and much more. It can be found at...

https://pdfhost.io/v...of_Contents.pdf

 

As far as picking a path forward, that is most difficult. I would make a couple recommendations. Do not go the route of using a benzo to treat your withdrawal symptoms. They are very addictive and can have a withdrawal just as bad as an antidepressant. Before going to another med which also has a withdrawal to treat your current withdrawal I would suggest trying some of the supplements in the ebook first. You can also talk to your dr about using either hydroxyzine or clonidine to ease your symptoms until they pass. They are both by prescription but do NOT have a withdrawal. 

 

As far as going on a new med for your depression...

 

Is your current depression from the Cymbalta withdrawal or even a side effect of the Cymbalta use? Only time can tell. As the withdrawal improves it will become more obvious if the depression is also improving or not. If the current depression is so bad that it can not be tolerated then you nay have no choice but to go back on another drug in order to deal with it. That decision can only be made by you. Whatever you decide we will support your decision and help in anyway we can. If you decide to try another antidepressant  to help i would suggest one of the following. Prozac, Lexapro or Zoloft. All three have a good tack record in treating depression and also the withdrawal symptoms from Cymbalta. The side effects from these three are typically less severe than from Cymbalta. If you read the ebook you will see that long-term use of Cymbalta can be quite a problem. Other antidepressants can be a problem as well but it is a matter of the lesser of the evils.

[invalidusername]

Hi LeftFoot and welcome...

 

Just to let you know, I have removed the other post as having two asking for the same will only confuse matters - far better to have all discussion in one place so other replies can see what is going on.

 

So, yes, I would agree with Hat totally, this was a taper too fast which has led to the other symptoms. Some people think that once one has stopped putting the substance into the body that it will start adapting, but your body will actively seek out all traces of the drug in all potential reserves in the body - and this can take some considerable time. The time you have been on the drug will also dictate how quickly your body will "realise" what is going on. 

 

Putting it bluntly, stopping at 15-20mg was the mistake. This point is crucial. 

 

There is no harm in trialing to see if this was the reason behind your insomnia, but it is then a game of patience to come off the drug. As hard as that might seem. 

 

I would also agree with Hat (we rarely disagree) that reinistating will not benefit you after this length of time. This should have been done within 3-4 weeks of stopping cold turkey as a maximum. That is not to say you cannot try, but it would be very hit and miss in our experience here on the forum. 

 

So am I right in saying that these issues (insomnia, anxiety, depression) did not exist when you started the Cumbalta for the original issue?

 

This is something we frequently see on the site as the Cymbalta also changes the serotonin and norepinephrine, so regardless of whether you took something to ease the issue of pain, it will also mess with other neurochemicals in the brain which will result in these issue at the point of withdrawal. If you look over the site, you will see plenty of people that have had the same issues as yourself.

 

If may be that you need to reinstate with another SSRI if things get too bad - again, as Hat said, it is the lesser of two evils, but there are plenty of other routes we could try prior to surrendering to that path...

 

IUN

[LeftFoot]

thank you, you folks are a godsend and a wonderful resource, we all feel so lost and alone in this! 

thanks for tip on benzos because they have been suggested to me. I downloaded the book last night and have begun reading portions.

I did start taking D3 and 5-HTP when I thought it might be related to S.A.D.

I don't think I have clinical depression, and the anxiety is definitely from the withdrawal. 

 

By the way, just a data point for anyone that may be searching for information on effectiveness of Cymbalta for nerve pain - I asked my pain management doctor to quantify how much relief his patients are actually reporting from using anti depressants. He said he believes the effect to be minimal, like a one point move on the Pain Scale.

For example, if your "Pain Score" (on a scale from 1 - 10) is normally a 7, then the AD might move you to a 6.

So clearly not worth it, given all the baggage. PM Doc is an anesthesiologist and deals strictly with pain patients. (The Cymbalta was originally prescribed by my GP.)

[invalidusername]

Cymbalta was not intended for neuropathic pain - it was used off label, so it should come of no surprise that this is the conclusion. Many drugs prescribed are done so "off label", more so that many patients would know.

 

There is a whole forum dedicated with the issue you are talking about - please forgive me as the name escapes me at the moment. But cymbalta was sold by Eli Lilly for the purpose who went to your GP about. It should not have been the first drug of choice. 

 

Make no mistake, the depression and anxiety are a direct result of the withdrawal, That much I can assure you. 

 

You need to be careful with 5-HTP. There are a lot of inferior products out there and can make matters worse than improve them. I would suggest you look at tryptophan or ashwaghanda in the first instance. Allopathic drugs have caused you this problem, so adding more to the mix, in my opinion, can only cause more confusion to the system. At least with organic, you can stop and start without any serious repercussions.

 

I don't like it when "professionals" take guesses as to what may or may not work for your particular circumstances. It is not right. And this is where forums like our own come into play. Whilst neither Hat nor myself are MD's, we have a combined knowledge and interest that often exceeds that of your average GP/primary and have an active interest in helping people has best as we can, rather than giving you your allotted 10 minutes and getting you out of the surgery!

 

IUN 

[LeftFoot]

thanks InvalidUserName, and you are correct, no anxiety or depression prior to Cymbalta. I did and do have problems sleeping, but that is mostly due to the chronic neck pain and back (multiple disc surgeries, etc.)

I'm kicking myself for becoming impatient and stopping too soon! My doctor definitely downplayed the risks like many others have reported. 

This week, my PM doctor prescribed Mirtrazapine, basically just treating it as depression, not withdrawal. He is a PM doctor and doesn't know about these drugs.

I took it for one day, felt horribly groggy and sedated, and developed a terrible Tic, with uncontrollable arm movements! After one day!

Anxiety is terrible in the afternoon and evening. For the past 3 days I have been taking Adavan twice a day, but I see Hat says to avoid them. So back to square 1!

I will ask about Hydroxyzine.

 

I know "your results may vary" but will ask anyway - Based on your experience with people that stop cold turkey from a lower dose, am I looking at 3 more months? 6 months? Just looking for some light at the end of the tunnel. Putting aside this whole Cymbalta mess, I still deal with terrible chronic pain every day. Piling this on top is pretty challenging. 

[fishinghat]

Just a couple of notes.

 

Mirtazapine has a bad withdrawal as many of our members have found out.

 

It usually takes a total of 6 months to a year to recover from this drop.

[invalidusername]

How are you doing LeftFoot?

 

As Hat said Mirtazapine can be a bit of a nightmare. Ironically it is used for the withdrawal to recreational drugs, but in itself can have its own issues. Quite paradoxical in that respect.

 

Regarding the recovery period, you may find that it comes around sooner, but it is difficult to see the progress from within, so I always suggest you keep a "mood diary" so you can observe your improvements more easily. You will look at your progress day-to-day, but is far better to evaluate on a weekly or fortnightly basis. You WILL improve but it is always a game of patience to await the better days. 

 

I really feel for you - and please let us know how you are doing. We are here for moral support as well as medicinal. We have seen so many different situations with our members and like to think we can draw on this experience in offering help.

 

IUN 

[LeftFoot]

not so good, but thanks for checking. Depression is up and down but biggest problem is anxiety and now agitation. These are new to me and I don't know how to deal with it. I am trying to make it to my first psych appointment next Wednesday, but also trying not to expect too much, suggested solution will probably be another SNRI or going back on Cymbalta. 

Im pretty close to just going back onto their crappy drug.

[invalidusername]

Great to hear from you...

 

One thing you need to understand and that is there may not be any respite in reinstating the Cymbalta after this length of time - it is different for everyone. But when you say that the depression is up and down, please understand this is likely a good thing, as your brain is trying to get balance again after coming off the drug. 

 

The anxiety and agitation is the depletion of norepinephrine. It can take a long time to stabalise. Just to use myself as an example, I was only on Cymbalta for 10 weeks (July thru September 2018), I was still having issues in March the following year. I could scarcely believe it myself and was driving me mad. Pretty much where you are. I just didn't know where to turn to.

 

IUN