19 replies to this topic

[Lizardgirl]

Hi all, I have been on duloxetine for around 3 months. I was initially on sertraline (Zoloft) and it worked an absolute dream, but I had a couple of side effects including excessive sweating, which I couldn't tolerate. My GP switched me to duloxetine and the side effects are exactly the same (albeit more tolerable as it is winter), but if I miss even a single dose, I feel horrendously ill. I am now trying to taper down, and either stop taking meds completely, or possibly go back to an SSRI if my anxiety is too high.

 

I am currently on 60mg, and today I counted 286 beads. This seems like a bit of a random number, so perhaps I mis-counted, but I took out ten beads and replaced the rest. I've read various studies on how best to taper, and it seems that larger drops of 10-20% at first can be well tolerated, and that gradually decreasing % drops as the numbers get smaller. Is this what is recommended on this forum? I chickened out of a large drop as I missed a dose a few days ago and the brains zaps and intense nightmares (anyone else??) have only just stopped. 

 

Apologies for rambling a bit, but my head is a bit fuzzy at the moment! I guess my question is, what kind of dosing schedule do people use? Say you lower the dose by 10% the first time, do you stay at this dosage for a couple of days? A week? Until any withdrawal symptoms have stopped? 

 

Any suggestions would be appreciated!

[invalidusername]

H Lizardgirl.. and welcome to our cozy corner of the Internet!

 

My immediate question would be "how long were you on sertraline"? Bearing in mind that it can take a good 10 weeks for the body to get used to it. In my experience, Doctors are too quick to pull the plug and move forward. The side effects you mention can often take time to ease.

 

So, you are now on Duloxetine (Cymbalta) and having the same problem - and this is after 3 months. THIS is too long. Any symptoms should have cleared up by then for sure, so you are right in thinking this.

 

Remember that statistics show that only 1 in 3 antidepressants word for any one given person, so it might be that you need to try another couple of SSRI/SNRI's to find one that works. It is horrifically tough and can be a year of what you feel is wasted. Rest assured, we have all be there....

 

What you mentioned in your second paragraph is bead counting and it the best way to get yourself off Duloxetine - regardless of how much of a pain in the ass it is! And yes, what you have read is correct. You have to think logarithmic. A 10% drop at 60mg is 6mg (10%), but at 10mg you need to maintain that same drop. It is never a case of dropping the amount of beads, but the PERCENTAGE of those beads.

 

The best advice is to listen to your body. Note that it takes a good 3-5 days for the effects of a drop to show, so be careful. Your system might be able to take more, but listen to your body!!

 

We are more than happy to help you out with a withdrawal plan, but I would first like to ask how you are feeling? What was the rason for starting out on an anti-depressant? Do you feel you would be better without, or are you ready to try another? 

 

Good to have you here - again, please feel free to ask any questions. We have all "been there - done that". You have my every compassion and will help all I can...

 

IUN

[fishinghat]

Welcome Lizardgirl.

 

It looks like IUN has got you off to a good start. It is good to see you have done some research and are on the right path.

[Lizardgirl]

Thank you both for the warm welcome. And thank you to IUN for such an extensive reply! The description about dropping percentages is really helpful, thank you. Today I removed 28 of the (roughly) 286 beads - is 10% a large enough amount to start with? I don't know whether to maybe try aiming for 50mg and see how I get on, so that the process doesn't take too long?

 

In response to your question about how I'm feeling - generally I am feeling well at the moment. I started taking antidepressants for panic/depression (due to my parents being very unwell - which is fortunately not an issue at the moment). The unexpected benefit of taking sertraline was that my long-term (largely ignored) anxiety just disappeared completely. I felt like a functional human being for the first time in over a decade, it was genuinely quite incredible! The fact that duloxetine has done nothing for my anxiety is another reason that I'm not prepared to take it any more, as I know that more effective drugs exist. I think I was on sertraline for around 6 weeks before stopping, maybe I should have stuck it out for longer. The withdrawal was unpleasant but fortunately only lasted two days.

 

My other question is that I'm not sure if the capsules I am taking are gastro-resistant or if it is the beads themselves? I ordered some empty capsules (the brand is Bulk) but they are not gastro resistant. My duloxetine information leaflet says 'The 60mg capsules are white to off white pellets filled in size 1 hard gelatine capsule'. From what I have read I believe gelatine capsules themselves are gastro-resistant. Would it be best to buy some empty gelatine capsules? I'm a little confused!

 

Thank you again!

[fishinghat]

"I don't know whether to maybe try aiming for 50mg and see how I get on, so that the process doesn't take too long?"

 

While I hope it is an easy wean for you it is best to take this slow until you see how sensitive you are. 10% is still I would not get greedy.  lol

 

"My other question is that I'm not sure if the capsules I am taking are gastro-resistant or if it is the beads themselves?"

 

There is a large section in our free ebook on the capsule/bead issue. The link to our free ebook is the first (pinned) thread in the Medical Support section. You need to be aware that when Cymbalta is exposed to stomach acid it is converted to naphthol which is very hard on the stomach. I usually recommend using an acid resistant capsule (not gelatin) even though the beads are enteric coated. Gelatin capsules take only 15 minutes to dissolve in the stomach. Not good enough in my book. Just my opinion.

[invalidusername]

Hi Lizardgirl,

 

Thank you for your kind words. We do all we can - the last thing we want is to see anyone suffer more than they have to.

 

"I don't know whether to maybe try aiming for 50mg and see how I get on, so that the process doesn't take too long?" 

 

We hear this all the time!! And whilst it is totally understandable, tapering too quickly can bring its own host of issues. It is really tough to be patient at these times. That said, we have seen members come off 3 months as quick as a couple of weeks, whilst others (admittedly very few) take a year or more. I personally  was on Duloxetine for only 10 weeks, and I was still having symptoms 6 months later, but again, everyone is different.

 

10% is fine to start, and I doubt you will have a problem going to 50mg. The early drops are a lot easier, it is when it gets towards the end that you need to be careful in how quick you drop. If you feel ok around the start of next week, then go ahead with the extra drop, but then make sure to give it more time...

 

Thank you for sharing your reasons for starting the anti-depressants. It is good to hear that the Sertraline worked so well for you, and regardless of what medical professionals will tell you, you really need to give these drugs time. When patients go to doctors and tell them to stop after 4 weeks because they had start-up symptoms, the doctor will just feel like they need to make the patient happy and suggest switching and it is not right. But the problem is that these drugs often have a lot of side-effects which cause people to stop taking them. 

 

Personally, I am on Citalopram, but I have been on 5 others, until I found that Citalopram was the right one for me. I have been fine for some time, and now struggling with the withdrawal, but is another story.

 

Regarding the capsules, they do need to gastro-resistant so they survive the trip through the stomach acids and break down further down the GI and absorbed by the liver. Gelatin does not necessarily denote that the capsule is gastro resistant. The packaging will usually state "gastro resistant" on "enteric", otherwise, it is to be assumed that they would break down in the stomach which you don't want. I found mine on eBay (UK).

 

Hope this helps you  - and keep in touch!

 

IUN

[looneytune]

All the best LG....can I borrow your man for a while?

 

 

Regarding the capsules, they do need to gastro-resistant so they survive the trip through the stomach acids and break down further down the GI and absorbed by the liver. Gelatin does not necessarily denote that the capsule is gastro resistant. The packaging will usually state "gastro resistant" on "enteric", otherwise, it is to be assumed that they would break down in the stomach which you don't want. I found mine on eBay (UK).

 

IUN, I was asking Mr Hat this very thing.....I was asking if my recent acquirement of GERD was likely due to Duloxetine or my DUL taper in ordinary caps ( not the GR type)

 and MR Hat says the GERD could be due to the Duloxetine or the taper in poor quality caps as the caps would irritate my stomach but I was reading elsewhere that the stomach (and acid)

would ruin the capsules ingredients not the other way around of the caps upsetting the stomach....are you with me/any thoughts?

 

 

[invalidusername]

 

All the best LG....can I borrow your man for a while?

 

 

LOL!! I am here for all as much as I can be...!!

 

If you suffer from GERD, the same as I do, then it is even more of a reason to be cautious of these sort of things. I myself have a hiatal hernia, which can only allow more capacity for the acidity produced by the gastric glands of the stomach. Even more so a reason for opting for the gastro-enteric capsules. 

 

With all due respect with the advice that Hat may have advised, I would err on the side of safety and go with the enteric capsules. 

 

Inevitably, they will be the best way you can approach the situation.

 

IUN

[looneytune]

Never had GERD B4 brother....it coincided with DEC head cold/chest infection and me using non gastro caps for tapers

[invalidusername]

The non gastro capsules shouldn't have had an impact on the GERD starting up, but I wouldn't put anything related to the stomach and GI too far past the withdrawal from Dulox...

 

IUN

[LeVana]

hi lizardgirl,

the reduction in the upper dose is a little bit easier than reducing the lower dose, cause of the receptor occupancy.

40-60mg dose duloxetine: 80% serotonine receptors are occupied (approximately)

30mg: 75% receptors are occupied
25mg: 72% (estimated)
20mg: 70%
15mg: 62%
10mg: 50%
5mg: 30%

the lower the dose the more greater number of receptors become free at once (!) - and this is what causes withdrawal.

that's why, please try to reduce sloooowly at the end.

greetz levana
p.s. sorry, but my english isn't very well...hopefully you'll understand my words ;-)

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[fishinghat]

You are right LeVana. In addition to the occupancy data, you also have to consider the sensitivity of the receptors as well. The binding sites on the Cymbalta molecule is not exactly the same as the binding sites on the norepinephrine or serotonin. Many researchers believe that these receptors actually adapt to the shape of the Cymbalta molecule in order to bind with it although there is no proof of that. They believe that this adaptation of the synapses is why it takes Cymbalta and other antidepressants so long to kick in (4 to 10 weeks) even though the serum levels of Cymbalta reach stable levels after 4 to 6 days. Once Cymbalta is discontinued these synapses/binding sites must again readapt to the neurotransmitter morphology.

[LeVana]

yes i also read that changed shape of receptors causes impossibility to bind other ADs and also endogenous serotonine for the first time after withdrawal. the more receptors are involved the more withdrawal can be expected. duloxetine also modulates MAO A+B and COMT enzymes and has a really short half time. i didn´t get so bad withdrawal when swichting escitalopram to dulox in 2010 - but the other way around it´s a nightmare i never expected to that extent.

 

i wish there would be more research on long term use of ADs.

[invalidusername]

 

i wish there would be more research on long term use of ADs.

 

Don't we all. My father has been told (off the record) that his Parkinson's disease was due to 20+ years on Citalopram.

 

I am now on 15 years of the same drug - same family genes etc - you can imagine what is going through my mind....

[invalidusername]

Regarding your math on the attached graphs are fine and you are certainly understanding the way you need to be thinking. 

 

It is great that you can research to this degree and understand all that is involved in a very complex withdrawal...

 

IUN

[fishinghat]

LeVana, do you mind if I ask for your educational level. You seem very aware of the dynamics involved.

[invalidusername]

LeVana, do you mind if I ask for your educational level. You seem very aware of the dynamics involved.

 

I wanted to ask the same, Hat!! It is very intriguing to find people of this educational level of the forum!!

 

It gets us very excited LeVana  

[LeVana]

i studied biology for eight semesters, had to break off ´cause of struggling with terrible anxiety for many months. as a result i took escitalopram for the first time and it helped so much (quite the opposite to today).

after recovery i completed an apprenticeship (after a break again) as a pharmaceutical technical assistant and worked in different hospital pharmacies. mostly in cytostatic and sterile drug productions til march 2023. loved my job and miss it.

[fishinghat]

Excellent LeVana. Great experience.

[invalidusername]

Absolutely - that makes for a nice resume. Well done for getting through it all.