22 replies to this topic

[condition]

Hello, I had a long time to post. Excuse me in advance for the long post. Male, around 50, with daily heavy alcohol  consumption in the past. 

After stopping alcohol, but also during the heavy drinking phase and for the last 25 years, I had problems falling asleep, especially the days before long voyages, Sundays, days before working trips etc. Obviously related to anxiety problem, with a mild depression. I was for a year (after cutting whiskey) in most SSRIs,

- zoloft 1 year, didn't help falling asleep but crushed any depression I had - mild weight gain

- lexapro 1 year, helped falling asleep in most cases but I had concentration issues  and more than 5kgr weight gain

- paxil for 2 years, not so hungry as lexapro but still hungry and reinstated alcohol in moderation but almost daily, helped to fall asleep, except for stressful situations or if I return late at home I couldn't fall asleep, but needed some help like half valium or half zolpidem 

- switching from half paxil dose to cymbalta 60mg, no cross tapering. At 60 mg it made me kind of obsessive with daily minor bothering things and not so understanding to other people. Eating less food than half paxil, but still more than my normal eating patterns, it brought me some sugar carving after couple of hours of taking it. Continued alcohol consumption in moderation and not daily. ABSOLUTELY no difficulty falling asleep with 60mg, "cured" a very old annoyance. I was so satisfied because of this.

 

I also have a herniated disk in the neck that causes me daily pain, chronic pain for decades. Cymbalta did nothing for that.

As the pain, especially the numbness from the nerve pinching made me stop going to the gym or cycling, I visited neurologist after 2 orthopedics, massage, chiropractor, physiotherapy etc. At that time I was taking 30 mg (slowly reduced 60 to 50 to 30).

So she prescribed (of course) lyrica, to start with 75 and titrate to 150. Cymbalta was prescribed by a PSY doc, so the neuro doc told me to simply stop using it, lol.

 

I didn't listen to her, but instead dropped from 30 mg cymbalta capsule to 20 mg yentreve capsule, both made by Lilly. I had brain zaps but controllable, as the lyrica started getting effect, also made me a tad more relaxed. Now the neuro prescribed the 150 mg lyrica, but I am reluctant to start. 

 

My biggest problem, now on yentreve 20 mg, returned: the lack of falling asleep. I am two weeks into 20mg, but since I have to wake at 7, if by 01:00 am not asleep I take zolpidem. Yesterday, for example, I hadn't taken any lyrica until around 23:00, when I returned home from a friend. I took besides the lyrica a clonazepam pill, as i wanted to sleep the soonest possible. However, I had some noise from inside the house and up to 01:30 I wasn't asleep, so I took half zolpidem additionally to the clonazepam. 

 

Tomorrow I have an appointment with my PSY, as the zolpidem run off. I only have now clonazepam, which more helps me recreationally rather falling asleep. As I talk about difficulty falling asleep with my neurologist, she prescribed additionally to lyrica, remeron 30mg, to begin with 15mg to help with my sleep.

 

1) I am also reluctant to begin remeron, but not if it can be used on demand, so if I take 10 or 15 mg occasionally, is it going to work? Do you have any experience about that, remeron to be used on demand for sleep?

 

2) With 30mg but the cymbalta pill (not yentreve), I had no problems with my sleep cycle, just occasionally an Atarax the night before a trip for example. If I manage to wean off cymbalta, I KNOW that I will have to take sleeping pills. Not daily, but some times per week. I understand that members had huge trouble withdrawing from cymbalta, but is it better for me personally, to take a 30mg dose daily at afternoon and avoid the occasional use of sleeping pills?

 

[fishinghat]

Welcome condition

 

Excellent detailed post. 

 

Before I get to your questions just a couple comments. What an off again on again mix of medications. This kind of history often seems to correspond to those with treatment resistant anxiety or depression. It has been shown that the more psych meds a person has taken the better the chance of not having any benefit from a change to another med. 

 

1) Remeron is often used as needed for sleep. Please note, it goes into effect very quickly so should be used just before bedtime.

     Also, 10 to 15 mg is a pretty low dose.

2) Just my opinion but if you look at the dangers that have been associated with the use of Cymbalta I would recommend that a             periodic use of sleep aides would be better for you.

 

One last note. During your post you mentioned recent use of ...

     Cymbalta

     Yentreve

     Lyrica

     Zolpidem

     Clonazepam 

     Remeron

     Atarax

 

All of these have significant withdrawals. It should also be noted that the Z medicines (like Zolpidem) react with the same synapses as a benzo (like clonazepam) and make a person more vulnerable to benzo withdrawal. Where I live drs have went away from benzo/Z medicines to Atarax and Clonidine for anxiety and sleep control. Neither has a withdrawal. 

 

There is also a good section in our free ebook on how to improve sleep and things to do and don't when suffering from anxiety or depression. The link is below.

 

https://www.keepands...meg?dn=y&dnad=y

 

You are going to have a million questions so feel to ask and be sure to read over the ebook and learn what has helped and hurt other members over the years as well as medical journal information.

 

Feel free to come back and don't hesitate to ask any questions.

[condition]

Thank you for your reply and for your welcome. I'm a very experienced at the use of antihistamines, as I am highly allergic and now spring period here. I usually take xyzal (Levocetirizine) but I can easily switch it to atarax, which is very cheap and highly available here without the need of prescription of course.

Zolpidem and Clonazepam pills have been prescribed long time ago to me and I use them only as needed and not daily. Once or twice per week maximum. Fortunately not an addiction there. The yentreve that I mention is the duloxetine capsule of 20 and 40 mg, no other brand here at these mgs all others are Cymbalta 30&60mg and many generics 30&60mg.

My neurologist put me on Lyrica for herniated disc and chronic neck pain. Apart from chronic neck pain my other problems are difficuly in falling asleep, sleeping lightly with the use of earplugs and some GAD and alcohol cravings. So I explained to the neurologist, who advised me to stop 30 mg Cymbalta and start Lyrica but I couldn't sleep because of the cymbalta discontinuation (I didn't discontinue as he advised, instead reduced to 20 mg) and ask him to prescribe me Valium, he said better remeron 15 mg. Neurologists here are reluctant to prescribe benzos that's why the appointment with PSY doc tomorrow.

I am reading the book slowly during the past 10 days thank you for this and for your advice that remeron may be used on demand for sleeping at a 15 mg dosage. I will try that very soon.

Also can you point me to an article with the permanent side effects from the chronic use of cymbalta? And do these side effects exist at a low dose of 30 mg? From your experience 30 mg is a low dose/can be used for years? I have read on this forum many things about discontinuation side effects, but I have not found yet the permanent damage articles, thanks.

[fishinghat]

There is a large section in the ebook on the possible damaging effects (both long-term and short-term) of Cymbalta. That section is called "Effects of Cymbalta on the Body" and starts on page 371. Most of those effects can begin within a few days of starting or after years on the med.  A lot these effects seem to be related to age, obesity (Cymbalta is fat soluble and collects in fat tissue) and length of time on the drug. 

[condition]

Ok, at first it seemed more general, concerning most SSRI/SNRIs, but I will go through again. It is more difficult to read than the first half of the book.

I am now at the supplements section. Do you recommend to start supplements like tyrosine now that I am trying to stabilize at 20 mg, or to save it for later lower doses.

Finally are the medicines Cymbalta and Yentreve exactly the same? Are you aware?

[fishinghat]

Well, I tried to post a list of things that most generally were successful for members but it wouldn't post so I am going to try posting it in smaller sections. maybe it was too big.

[fishinghat]

I would save taking supplements until symptoms are pretty severe but that is up to you. 

 

 

 

Some of the things that has helped a lot of people are...

 

 

 

Items Proven to Help Many with Cymbalta Withdrawal.

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Diphenhydramine, (over the counter) also known as Benadryl, is an antihistamine and as such is not only used for allergies/colds but also as a sleep aide. It does have a mild anxiolytic effect. May lower blood pressure and cause irregular heartbeats. Your body does build up tolerance to it after a few weeks. This medicine has many drug interactions.

Begins working in 15 to 30 minutes

Peak levels - 2 to 2.5 hrs

Half Life – 4 to 6 hrs

Use by members for anxiety releif and to help sleep is too numerous to mention. 

Diphenhydramine should NOT be taken with hydroxyzine. Drugs.com

 

serendipity - I found Benadryl to produce hangover effects, and cause palpitations when taken long term. Even if you wake up in the middle of the night, and can't get back to sleep, even a teeny amount (say, 15mg) can induce sleep again. 

Schmb - Benadryl worked on a limited basis for me, because sometimes it makes me jittery, and that only made the zaps much worse, so just use some caution in case you are sensitive to it.

FH - One caution on benadryl. It is famous for bad reactions with other medicine so check your compatability closely. The maximum dosage of benadryl is 25 to 50 mg every 4 to 6 hours and do not surpass 300 mg in a day.

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Benadryl Total

 

Medicinal ingredients:

•Acetaminophen, 500 mg

•Diphenhydramine Hydrochloride, 25 mg

•Pseudoephedrine Hydrochloride, 30 mg

 

It contains diphenhydramine which is the active ingredient in regular Benadryl and also pseudoephedrine which is common in most cold medicines. The Diphenhydramine helps with sleep and anxiety and the pseudoephedrine helps block the action of adrenaline which produces a calming effect. 

[fishinghat]

Omega 3

 

Dose - Omega 3 is recommended at 2000 mg/day EPA and DHA for anxiety, give or take a couple hundred depending on what research you read. It has been shown that only the EPA and DHA components effect anxiety. Any other omega 3 fatty acids don't do anything for anxiety. Life Extensions, Mega EPA/DHA, is distilled (molecularly purified) so you don't get any impurities with your product plus it contains no mercury. Some even provide a certificate of analysis if requested. They also have ones that are enteric coated now that will not irritate the digestive track and has no fish burbs to them. 

 

http://www.cymbaltaw...elps#entry67706

This thread contains a detailed discussion on use of Omega 3.

 

Also this thread....

http://www.cymbaltaw...elps#entry68036

 

Fishinghat - Omega 3 fish oils can be very high in mercury depending on the type of fish used. Some have tested at over 300 ppm mercury. There are brands out there that are mercury free or low mercury guaranteed. Something to think about. If you have thyroid issues they usually contain high iodine concentrations also. One member had an episode of high iodine toxicity I couldn't find a iodine free product. If your thyroid is fine then this should not be an issue.

 

FH - Cod liver oil you buy in the store may be high in mercury and pesticides. The liver is the pollutant filter for the body. Cod livers are from the top of the food chain and pollutant levels are usually significant. Be sure to get one that is purified and verified mercury free. But I don't believe there is one verified pesticide free. Great care must be used in selecting one. It also contains fairly significant levels of vitamin A and D and toxic doses are known to occur. Routine blood analysis for Vit A and D should be done every 6 months if using Cod Liver Oil or any Fish oil.

 

Warning

Arrhythmias

Omega 3

3 Grams of omega 3 per day can worsen cardiac arrythmias.

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Melatonin

FH - a research article where it was shown that taking 0.7 mg of liquid melatonin under the tongue (sublingual) helps with anxiety. Place it under the tongue until dissolved and gone. In case you are not familiar with melatonin it is the chemical your body produces in the evening to make you sleepy and ready for bed. 

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[fishinghat]

Gatorade

 

Many members found Gatorade to be considerable help in fighting most withdrawal symptoms, especially the green gatorade.

 

Kindorf - Also I have been avoiding caffeine so I cut out my coffee and sweet tea.

I replaced then with fruit juice, ( mainly apple juice ) water and Gatorade. Today no stomach cramps I think they are done. No diarrhea, Lord I hope that is gone. 

 

Judy -  I knew that Gatorade helped with the light-headed, "floating brain" feelings. 

 

watchdog -  Drinks LOTS of GREEN gatorade..... don't know what the deal is, but it helps.

 

wiraz - Drink at least one G2 Gatorade a day – stay away from the full sugar version, leads to a higher chance of diarrhea. I drink one 32 oz bottle every day plus tons of water!!

 

caroline - Vit E also for head and joints and then Gatorade's G2. I didn't want the sugars so I went with the G2

 

Rafael -  I have mild brain zaps but I believe the omega 3 Fish Oil and Gatorade are helping.

 

Sandlion - I took fish oil/other Omega 3 and also found that Gatorade helped -- maybe it's the salt replacement after all the nightsweats.

 

guppie -  I'm a month off the drug so only minor zaps now and then. Whoever gave the gatorade advice is a genius. That treats them instantly (make sure you get the low calorie gatorade since regular is high calorie). Brain zaps are minor. I grab a gatorade and that gets rid of those for a bit (electrolytes). 

 

Alisha - gatorade-had one of the big bottles yesterday and it did seem to help,

 

Vinvin - The Fierce Green Apple Gatorade, Dramamine and Boylan's Ginger Ale seem to help out as well 

 

Summary - Many members mentioned drinking Gatorade for the electrolytes after diarrhea, night sweats and when having brain zaps. G2 was often mentioned because it has no sugar (not true, see below). Also, it was suggested that one should not just rely on Gatorade alone for hydrated but should also drink plenti of water. Green Gatorade is highly recommended by some members.  Vitylite and Powerade were also mentioned a couple times for electrolytes. I would also recommend Isopure as it comes with and without sugars and proteins with a similar amount and type of electrolytes as Gatorade.

 

G2 Gatorade - It has the same amount of sugar as regular Gatorade and nearly all the same ingredients and electrolytes.

 

Gatorade Fierce Green Apple Sports Drink - This may be the "green  gatorade" that members spoke of. It contains malic acid, the active ingredient in apple cider vinager which has proved so helpful to other members. Other ingredients are the same.

 

Isopure Zero Carbs - No sugar, with some calcium. Contains Malic acid

Isopure Mass - With sugar and proteins, with calcium, Contains Malic acid

Isopure zero carb with proteins - no sugar, contains proteins. With calcium  Contains Malic acid

 

Sparkybird - I’ve found that Pur Aqua Sparkling Frost in any flavor has malic acid. I discovered it by accident. It is only 50 cents at Aldi’s. It is only 10 calories a bottle.

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L-theanine 

 

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

 

Member's comments

 

(puritan's pride) 200 mg capsules 2- 3/ day. I have been taking this prior to cymbalta detox. It helped me reduce my dosage of clonazepam. Within 20-30 mins I feel more calm. I do believe it is helping keep the anxiety in check.

 

Tinabee - For now I have started taking fish oil and a supplement called Theanine Serene that is supposed to help with anxiety. I know it sounds silly since I've only taken the anxiety supplement for a couple days but I really feel like it has helped.

200mg L-Theanine in the morning with a full glass of water on an empty stomach, you can take again in late afternoon 100 to 200 mg if needed (make sure it is suntheanine - it helps with headaches and pain as any painkiller I had just did not cut it)

[condition]

Hi fishinghat, thanks, to clarify

 

1) Isopure: unfortunately it is not available anymore in EU online stores and I am unable to order. Can I use an alternative Whey, like Optimum Nutrition's Gold Standard Whey, or even better ORGAINIC Organic Whey Protein Powder, my current whey protein, nutrition facts following 

 

2) Benadryl: again not available locally however there is Atarax as alternative, can it susbtitute Benadryl? Or maybe some other 3rd gen antihistamine, like Xyzal etc

 

3) Omega 3: I am in possession of Nordic Naturals Ultimate Omega 3, very popular in the US from what it says in the container, what dose should I use to have the said effect? Nutrition values as follows: 

 

4) And finally amino acids: You mention L-Theanine above, but in the book it seems that L-Tyrosine is the amino acid to begin with. Can you clarify, if I was to start with one amino acid, which one would it be? Swanson N-Acetyl L-Tyrosine 350mg is available for example.

 

Thanks

[fishinghat]

Sorry for the delay, I was out of town yesterday.

 

1) This product seems suitable BUT one of the key differences is your product does not contain malic acid which appears to be a constant in those drinks that members had good luck with. Otherwise the whey product looks good.

 

2) Many antihistamines help fight anxiety but those primarily effect the H1 receptors.

 

     Hydroxyzine, (Vistaril, Atarax) - is an H(1)R antagonist, is very effective against anxiety in most people but some get no help             from it at all.

 

     Diphenhydramine is a histamine H(1)R antagonist in the brain.

 

     H2, H3 and H4 receptors are primarily involved in allergies, immune response, acid control and other issues.

 

     Obviously, you can not take Diphenhydramine and Atarax at the same time. Also, You do not build up tolerance to atarax but             you do to Diphenhydramine.

 

3) This looks good. While it does not say if it is purified by molecular distillation (that removes mercury from the product) the wibsite       does offer analytical results on each batch of product.

 

4) L-tyrosine seems to be most effective in members who suffered from depression while L-theanine (Suntheanine) seemed to be more effective in those with anxiety HOWEVER that did vary a lot. Remember that l-tyrosine can be converted to dopamine in your body which is good but then it can be further converted to norepinephrine and adrenaline which would increase anxiety. Unluckily there is no clear method to tell in advance which one will work best for an individual. My recommendation when trying ANY supplement is to take a very small amount first and slowly work up the dosage until you get to the level you wished to try out. This helps minimize any side effects or allergic reactions.

 

At this point I may be out of town tomorrow as well but I am not sure. Hang in there.

[fishinghat]

As i have time I will feed you back some info on these supplements.

[condition]

Thank you for your detailed reply. I thought that I had enabled email notifications for this topic, but I didn't. On a side note, this board is not so mobile friendly, last time I “lost” my reply when switching to more options. The autosave feature didn't work for mobile.

 

The meeting with the PSY went well, of course he found the 20mg duloxetine dose (yentreve) dose that I am on, very low and prescribed xanax, for months LOL, after my request.

I have around 3 weeks that I reduced duloxetine from 30 to 20 mg. First week I experienced brain zaps but with the help of lyrica, that my neurologist prescribed and the PSY agreed, I now almost stabilize and sleep well, without any additional med taken, benzo or whatever apart from xyzal (Levocetirizine), a 2nd gen antihistamine. I have to use antihistamines daily on spring period. Now I followed your advice and save the supplements for later, for a lower dose of cymbalta.

 

1) Malic acid: I understand, I think I got it. My protein is pure whey without additives, I searched and found some with malic acid, including one from Optimum Nutrition. That been said I prefer unflavored whey, so I will look for the mentioned green gatorade. 

2) Antihistamines: I am not sure I understand the comparison  between Benadryl and Atarax, 

Hydroxyzine- is an H(1)R antagonist,

Diphenhydramine is  H(1)R antagonist in the brain.

 

 

Does this mean they are the same H(1)R antagonists? As I said Benadryl is not available here, Hydroxyzine though is cheap and available without prescription.

 

3) Omega 3: So I have to exceed the recommended dose of two tablets and take 3 tablets daily in order to get the withdrawals' recommended dose of 2000mg EPA DHA?

 

4) Amino Acids: OK I will skip these till I reach the 10 mg duloxetine, further ahead in my tapering schedule.

 

At the moment I stopped smoking for about a year and switched exclusively to vaping, mostly herbs with THC/CBD. I found them very relaxing.

 

Additionally I opened one capsule of 30mg cymbalta and another one of 20mg yetntreve to see the beads. They look almost identical apart from the brighter white color of the 30 mg capsule. I think I will go ahead with my tapering with the second capsule, to cound less beads. Initially I have to remove some beads like 5 beads only, if I understand correctly, they should be around 50.

 

[fishinghat]

1)  i would appreciate it if you could provide details on the Optimum Nutrition product. This is hiw i learn. Also please keep us informed as to any benefits or side effects that you may experience.

 

2) Yes, both Benadryl and Atarax have the same reaction with regard to H1 histamine receptors however due to the slight difference in the shape of the molecules one becomes tolerant of Benadryl fairly quickly. Obviously the two should not be used together. Just for your information, although Benadryl may not be sold where you are its active ingredient (diphenhydramine) can also be found in many sleep aides.

 

3) You may have to go to 3 capsules. Some received benefits at 2,000 mg but 3,000 worked better in general. Try 2 capsules and if you need to you can always go up to 3000 later. 

 

The comment on the vaping is interesting. One of our members, IUN, is our guru on all things Cannabis related and much more. I am sure he will find that interesting as well.

 

A little clarification on the beads please. So you will be using the 20mg yentreve right? How many beads in a 20 mg capsule? You plan to remove 5 beads to start?

 

I am sorry I was not around much the last 3 days but sometimes life happens if you know what I mean. 

[condition]

 

A little clarification on the beads please. So you will be using the 20mg yentreve right? How many beads in a 20 mg capsule? You plan to remove 5 beads to start?

 

Thanks, the beads should be around 60 to 75. Since I did a big drop from 30 to 20 mg, my plan after that is to stay for a month at 20 mg and then start counting beads. I haven't counted yet for psychological reasons. I knew from the start that I would have to count beads eventually, since I am not a new member here, and I have read the forums before starting cymbalta. So the plan is to drop 5% each month, but we will see. 

 

Counting beads may not be the best thing, it is very accurate, though. I have used the weighing method for escitalopram, but although I had a mg scale, it wasn't accurate and very messy.

[fishinghat]

I understand. Thanks for the information.

 

We certainly have had many long and detailed discussions on this site about the inaccuracies of bead counting, weighting, etc.  Really the only truly accurate way is a compounding pharmacy that uses liquid Cymbalta to make up the various doses but this can be very expensive and some do not use the liquid form but use bead counting anyway.

[condition]

Thanks, but how can the bead counting be inaccurate? I thought it was the most accurate but time-consuming method (pain in the ass to count the beads and replace the on a capsule).

[fishinghat]

The reason it has some inaccuracy is that the beads vary in size to a degree BUT the thickness of the enteric coating is consistent. This means that the actual amount of medicine within the bead varies quite a bit. There is an excellent thread on this subject in this site but I can't find it. I will do a deeper search later.

[condition]

Thanks but this is bad news for me. All known brands duloxetine beads vary in size? 

[fishinghat]

All, but of all the methods, bead counting seems to work the best.

[redbird22]

Anyone have any thoughts on the brand "NOW" for vitamins and fish oil and herbs? From what I can tell it's a good brand, but I want to take the best possible. Organic, free of mercury, no chemicals, etc. If you could give me a link to the best fish oil with all these elements, that'd save me a bunch of time. my free time is little these days. Thanks in advance! All you guys are wonderful! 

[fishinghat]

Now brand is OK. Basic but good. 

 

On the Omega 3 I have always recommended ....

 

Amazon.com: Life Extension Mega EPA/DHA – High Concentrated 2000mg Omega 3 Fatty Acid Fish Oil Blend Supplements - for Heart, Brain & Joint Health Support – Gluten-Free, Non-GMO – 120 Softgels : Health & Household

 

This is high in EPA and DHA omega 3 which is what is needed for both the withdrawal and brain fog.

 

They will provide a certificate of analysis if so desired for any lot number you purchase.

[invalidusername]

NOW have been an up and coming brand for a while now. If there was anything really untoward, they would have been called up on it by now.

 

But you are right to look for absence of heavy metals. It is not so much of an issue in the short term, but always better to find the better manufacturers.

 

IUN