289 replies to this topic

[EBB]

Thank you, very interesting. What I want to know now are the implications for me...

1. So the long and short mean that this is probably withdrawal related and should improve as withdrawal fades and my body heals?

2. Should I see a urologist or just be patient and give this time?

3. Does that mean i could have frequent urination and bladder pain for 2 years, not to mention anxiety, no appetite, no good feelings? I thought wd was shorter than that 

4. And would taking Zoloft potentially stop the yo yo-ing? And calm the nervous system?

5. Even in a person with a crappy gene mutation for SSRIs?

[EBB]

Also FH, in addition to above, does this mean my withdrawal is getting worse? I haven't really had a window in a few days and I'm getting worried. Now this. Am I moving backward?

[fishinghat]

1. Yes
2. A urologist wouldn't know about Cymbalta withdrawal symptoms so if he can't find anything he will probably run a bunch of tests and then send you to a neurologist. On the other hand it is better to be safe then sorry. This usually lasts around 2 months.
3. No those symptoms do not last that long as you heal the symptoms fade. Usually by the 6 to 8th month most symptoms are gone or much better. You may not feel fully normal but a lot better. The rest fades with time.
4. Yes. But remember it is a transport inhibitor as well so if you ever decide to come off of it you will still have a withdrawal and the yoyoing although not as bad as Cymbalta typically.
5. That is the big question. That "bad" gene just lowers your odds of it helping but it is still possible.

"Also FH, in addition to above, does this mean my withdrawal is getting worse?"

No, one thing I don't understand about these withdrawals is they seem to follow a pattern. First stomach issues, then head congestions, brain zaps and dizziness, followed by emotional swings, and etc. Most of these stages usually only last for 2 moths or about with the exception of the emotional swings which make up the heart of the symptoms.

[EBB]

Thank you FH, I'm hopeful hen that I won't deal with this too long. On another issue - blood pressure. I took both .1 Clonidines today and less hydroxyzine than yesterday. I'm feeling very yucky. Woozy, nauseous a bit, lightheaded, spacey, dizzy when I stood up a couple times. I'm drinking tons of water. When I took bp last it was 94/58. Does my body adjust to this med? Or am I just going to feel crappy and lethargic if I take this much?

[gail]

Ebb, what is your usual BP? Thanks.

[fishinghat]

You will adjust. It should only take a few days for the bp to stabilize as well as the yuckiness. I would take 1 1/2 clonidine today and then 2 again tomorrow. Most people are not that sensitive to the clonidine but you will adapt.

[EBB]

FH,

I think I'm getting worse. I haven't had a window in a week. I had a very stressful week - my husband was gone, my period came so hormone hell and this bladder thing started. But, my thoughts and worry are out of control. I haven't had any good thoughts or feelings and no windows since last Monday. Nothing is helping. I'm breathing, visualizing, going to therapy, eating well, doing reiki. Is this just a bump? Is this going to end? My family is so worried. I also have the BDNF Val/Met gene that's involved in neural plasticity. Could this make me not able to stabilize and get better?  I am very discouraged. I slept so bad last night, even with hydroxyzine and Ativan. I also have the COMT Met/Met gene. Could these gene issues prevent me from healing and improving? I've been under A LOT of stress this past week but I'm scared by how badly I feel and that I haven't had a window, not even a bit. I'm super scared.

[EBB]

Also FH, is it possible the Clonidine is making me MORE anxious? The very first day I took it I felt relief and I never felt that again in my mind (last Monday). I've just felt tired and woozy, not like myself. I don't know what's going on.

[fishinghat]

BDNF Val/Met gene

https://www.ncbi.nlm...les/PMC2735856/
https://en.wikipedia.org/wiki/Rs6265
https://www.frontier...2015.01212/full
http://journals.plos...al.pone.0149911
http://psycnet.apa.o.../2014-10111-001
https://www.snpedia....php/Rs6265brain

Some light reading. lol

Has been linked to decrease in memory and function as we get older. Increased anxiety and more.

[fishinghat]

COMT Met/Met gene

https://www.scientif...robotic-swarms/
https://www.ncbi.nlm...les/PMC4228295/
https://www.selfhack...omt-v158m-gene/

A pronounced elevation in worrying and anxiety.

[fishinghat]

It is possible that clonidine is causing excess anxiety. The FDA reports that side effect in 5% of the users. One way to find out. Stop taking it and see what happens.

 

From what I have read these genes will not stop you from healing but could slow down the process significantly. The increased stress you have been under this week clouds the issue as it will certainly cause a relapse in symptoms.

[EBB]

What does "slow down the process significantly" mean?? I can't read those links because they are going to stress me even more. But thank you, maybe I can at some point.

How bad is this? Does this mean I'll be in withdrawal a longer time than 8 months? What can I expect? Does this change anything with regard to trying Zoloft/Effexor? It seems you lean toward Zoloft because it has less side effects and an easier taper. I don't want to take Effexor. It is so strong and if it doesn't work I'm stuck. Can I make it through this? I am so miserable. I don't know what to do. I know you can't tell me what to do - what would you tell your wife to do? Do these gene issues change anything except make me very very scared and hopeless?

[fishinghat]

Well I just had a nice long explanation and was ready to post but lost it. Urggg.
 
Lets try a summary.

"What does "slow down the process significantly" mean??"

Your withdrawal will take longer to fade.

There is no information out yet on these genes and how they effect treatment but the thought is they make treatment more difficult.

I know that one of those genes causes significant increases in dopamine so a dopamine inhibitor may help. If you want me to look into that let me know.

My wife? Well I would tell her the same thing I am telling you. This is a decision I couldn't make for her. All I can do is inform as best as possible. I will do some more reading the next few days to see of I can find anything else on these genes.

I am eager to see if stopping the Clonidine relieves some of your anxiety so that you get some periodic breaks every now and then.

[EBB]

So my husband wants me to continue the clonindine a couple more days. He feels my anxiety is from the hormones, travel and week from hell. He feels it's too soon to eliminate it yet because the week was so weird. It did give a nice calming response the first time I took it. Also I didn't yet mention I have a single mutation of the MTHFR gene, so my methylation sucks.

Questions:

1. Why would these genes make withdrawal longer to fade and how much longer? This is true suffering. I know you know this. I don't get how the mutations would make withdrawal longer - because things work inefficiently?

2. So what would you do if you were me? Get the Zoloft going? Do the Effexor that is in the category that is supposed to be effective?

2. Will I be feeling this bad for a long long time? Every day is really tough. Are you saying I'm going to feel this doom and anxiety for years?

3. I'd love your help in looking into ANY treatment that might help. I am miserable.

4. Am I doomed?

[EBB]

In addition to above, isn't dopamine a good thing? Why would high dopamine be bad??

I guess my bottom line is it now seems like I will be in withdrawal for "a long time." Will I feel this bad for that whole time? Am I just left to suffer?? I don't think I can.

[fishinghat]

1. Yes, the chemical mechanisms do not function properly in controlling the neurotransmitters.

2. Just me but I would wait until I see how much good can be accomplished with the clonidine and hydroxyzine. If not good enough I would talk to the dr about your genetics an using a dopamine inhibitor. If that does not work out then Zoloft.

Second number2.
It simply is not known how much it will lengthen your withdrawal.

3. Will do.

4. Lets say at this point you have a challenge ahead. Lets see what research I can find.

Dopamine is used as a neurotransmitter in the body. Any unused dopamine is converted to norepinephrine and norepinephrine is converted to epinephrine (adrenaline) ergo the anxiety.

You won't feel this bad forever. There will be some slow improvement. How much and for how long is unknown. I do believe it is our best option to look for a successful treatment for your withdrawal.

[EBB]

Thank you. I'm now terrified.

1. Does the genetics mean the 2-year healing does not apply to me?

2. Why slog this out without adding an AD? Aren't I going to need to be on a med with all of these mutations and history of ADs and because "the chemical mechanisms do not function properly..."?

3. Could I be one of those people in withdrawal for years?

4. What do I do when the Ativan runs out?

[EBB]

Also, would a dopamine inhibitor help the withdrawal? If it were the last 6 days I would say the clonidine and hydroxyzine and ativan is NOT good enough. Again, I've had no windows for days. Is it possible I'm getting WORSE?

[fishinghat]

This is all the treatment details I could find but I can't say I feel warm and fuzzy about these results. Just not enough known yet.

SLC6A4 in the L(A)/S form
This form cause depression and depression.
Patients (especially of european descent) tend not to respond to ssri and as such treatment is more likely to succeed if a non-ssri AD is used.

BDNF Val/Met gene
A cause of bipolar disorder.
Lithium and valproate (Depakote) responses better in Val/Met gene than other BDNF genes.
This gene morph did not alter the effectiveness rate of Effexor.
This gene type usually predicts that antipsychotics are ineffective.

COMT Met/Met gene
Individuals With COMT Variant Show Exaggerated Reaction to Aversive Stimuli
venlafaxine (Effexor)and lamotrigine ( Lamictal) have been used successfully to treat this condition.
By itself Effexor has limited effectiveness.
This gene may lead to ADHD and can usually be treated with low dose amphetamines but usually suffer adverse reactions.
Creates higher amounts of dopamine in the frontal cortex.

[EBB]

Thank you for the info - what does this mean tho? It seems like Effexor is a way to go? How bad is that to try? What would you do? Would Effexor improve the withdrawal??

[fishinghat]

1. It simply indicates that you have a higher risk of a longer recovery than most people.

2. It is a likely you will need to be on a med but which one? There simply isn't enough information on these genes to make an educated guess.

3. It is possible if you can not find a med to help.

4. Don't worry about it. Ativan is a short term help and will not help in the long run without major increases in dose. The trick is to find something that will bring you relief and then when stable you can get rid of the Ativan

 

It is very possible that a dopamine inhibitor will help your withdrawal. I will look into that tomorrow. You will really need to talk to your dr about the genetics and the possibility of using a dopamine inhibitor. By lowering your dopamine levels some you will produce less adrenaline in the long run leading to a calmer person. At least that is the thought.

 

Actually I am not surprised by the down turn. They come and go during withdrawal. If it is a bump in the road it will settle down in a few days. If not then try stopping g the clonidine and see if that helps. What is your dose of hydroxyzine right now?

[fishinghat]

I am not sure what to take away from that info. Likely that Effexor should help your withdrawal but of course it has a lot of side effects and like all ADs results vary. Sorry no clear cut answers here. These three genes cause such an instability in your emotional state it is not obvious what to pursue.

[EBB]

I'm taking around 100 hydroxyzine during the day and around 75 at night.

[EBB]

Is there anything I can hold onto for hope? I can't feel this way for years

[gail]

Hi Ebb,

Hydroxyzine and Clonidine are good meds, but they don't work as well on everyone as they do for Fishinghat.

With 15 years being on antidepressants, I really suggest that you try the Zoloft or the effexor route.

I would say that may find HOPE by trying one of the above. Or something else that your doctor might suggest. Seroquel helped me also, might help you. By the way it was instant, but didn't last. You cannot continue like this and I think that deep inside you know this.

[fishinghat]

That is a good dose of hydroxyzine and should be enough. If things continue to be bad I would seriously consider coming off the Clonidine in case it is causing the extra anxiety. Before clonidine you were at least able to have some good days here and there. After that most likely the Effexor. I am still looking into the dopamine inhibitors. Be back later.

[fishinghat]

Ebb, have you ever tried Wellbutrin?
 
Wiki - Bupropion, sold under the brand name Wellbutrin. Bupropion acts as an norepinephrine-dopamine reuptake inhibitor (NDRI). It has less side effects than most antidepressants but more drug interactions than most. It commonly causes weight loss.

[fishinghat]

Sertraline (Zoloft): This is an antidepressant drug that functions primarily as an SSRI. It tends to primarily increase the amount of serotonin in the brain. However, it is unique compared to other SSRIs in that it also acts as a dopamine reuptake inhibitor. In fact, it influences dopamine reuptake to a greater extent than the NDRI drug Burpropion. Therefore it could be technically considered an SDRI or serotonin-dopamine reuptake inhibitor.

 

Well, you learn something new everyday. Zoloft not only regulates serotonin but also dopamine. It is more effective in controlling dopamine than Wellbutrin. Something to think about.

[juli]

EBB - I am on the bipolar spectrum so Lexapro would not be enough to manage my depression and anxiety.  However, it has been a miracle drug in managing my withdrawl from Cymbalta.

 

I would try the Zoloft.  Nothing to lose.

[EBB]

Hey FH,

I just went to doc and spoke with guy from genetic testing place. Contrary to what you said, they both said that Zoloft, being a slight dopamine reuptake inhibitor would actually ADD dopamine to my brain. They are saying that Lexapro would be a better choice because it does not have a dopaminergic effect. Am I misunderstanding something you said? I felt like you were saying Zoloft would be good to try because it would "regulate dopamine." It seems it would in fact increase dopamine. What are your thoughts? In terms of controlling dopamine, they suggested adding Abilify or Seroquel to regulate dopamine. Although OF COURSE I have a gene that shows I may get weight gain with this.

Thank you so much for all of your help, I am so grateful. Wondering what you think about all of this now...